CASE Melanoma Maligna
-
Upload
ushagi-chan -
Category
Documents
-
view
227 -
download
0
Transcript of CASE Melanoma Maligna
-
8/11/2019 CASE Melanoma Maligna
1/29
CASE REPORT
MELANOMA MALIGNA
SEKAR KAMULYAN HOSPITAL
CIGUGUR-KUNINGAN
2014
Raisa Yohana Miharja (0915081)Vania Azalia Hariyanto (0915100)Sahala Triyanto Simamora (0815129)
Budyatmoko Gondo Suryoko (0715146)Fransiskus Balpon (0515178)
Preceptor:dr. Antonius K, SpB, FInaCS
-
8/11/2019 CASE Melanoma Maligna
2/29
Patient Identity
Name : Mr. D Age : 60 y.o Admission Date : June 18 th , 2014 Room/ Ident.no : Elisa/ 162879 Sex : Men Address : Tegaleja
-
8/11/2019 CASE Melanoma Maligna
3/29
History Taking
Autoanamnesis and heteroanamnesis (daughter) Chief complaint: pain on the left sole Pain on the left sole for about one year. Three years
before, there was a black flat round lesion as big as
bean, with irregular border, pain (-), bleeding (-), pus (-),getting bigger to as big as tennis table ball, a little bitprotruding, there was a wound but no bleeding, itching(-), pain (+) especially when walking.
-
8/11/2019 CASE Melanoma Maligna
4/29
-
8/11/2019 CASE Melanoma Maligna
5/29
Physical Examination General state : good
Pain status : moderate Awareness : compos mentis Nutritional status : good
Vital sign
Blood pressure : 120/70 mmHg Heart rate : 68 x/minute Respiration : 18 x/minute Temperature : 36,6 oC
-
8/11/2019 CASE Melanoma Maligna
6/29
Skin : icteric (-), anemic (-), cyanosis (-) Head : anemic conjungtiva -/-, icteric sclera -/-, round
isocor pupil, d 3mm, pupillary reflex +/+ Neck : No palpable lymph node Thorax :
Cor : S1, S2, regular, murmur (-) Pulmo : VBS +/+, Rh -/-, Wh -/-
Abdomen : flat, BS (+) normal, tympanic, tenderness (-) Inguinal : palpable left inguinal lymph node, d 3 cm, soft,
flat, immobile, pain (-) Extremity : warm , CRT < 2
a/r left sole : black round lesion, d 4 cm, irregular border, alittle bit protruding, ulcus (+), blood (-), pus (-). Anus & rectum : in normal range
-
8/11/2019 CASE Melanoma Maligna
7/29
-
8/11/2019 CASE Melanoma Maligna
8/29
Differential Diagnosis
Melanoma maligna a/r left sole Ulcus decubitus a/r left sole
-
8/11/2019 CASE Melanoma Maligna
9/29
Working Diagnosis
Melanoma maligna a/r left sole
-
8/11/2019 CASE Melanoma Maligna
10/29
Management
Wide and deep excision on June 19 th , 2014 13.00 D/ pre op : Melanoma maligna suspect a/r left sole D/ post op : Melanoma maligna suspect a/r left sole
-
8/11/2019 CASE Melanoma Maligna
11/29
-
8/11/2019 CASE Melanoma Maligna
12/29
Post operation instruction
TTV monitoring Fasting : until fully awake IV line : Futrolit 20 gtt/minute Medication : Ceftriaxone vial 1gr 2x1 IV
Toramin 3x1 amp IV
-
8/11/2019 CASE Melanoma Maligna
13/29
Prognosis
Quo ad vitam: dubia ad bonam Quo ad functionam: dubia ad malam
-
8/11/2019 CASE Melanoma Maligna
14/29
Melanoma Maligna
-
8/11/2019 CASE Melanoma Maligna
15/29
-
8/11/2019 CASE Melanoma Maligna
16/29
Definition
Malignant melanoma is a neoplasm of melanocytes.Although it was once considered uncommon, the annualincidence has increased dramatically over the past fewdecades.
-
8/11/2019 CASE Melanoma Maligna
17/29
Epidemiology Whites > Asian and black populations (20x). Men > women, the prognosis is slightly better for women. Arise more commonly on the lower extremity in women and more often on
the trunk and head and neck in men. Can occur at any age, the median age at diagnosis is in the range of 45 to 55
years. Accounts for only 4-5% of all skin cancers but causes the majority of deaths
from skin malignancies. The eighth most common cancer in the United States. Estimated: 62,190 new cases diagnosed and 7910 deaths in 2006. The lifetime probability of melanoma developing is 1 in 57 for males and 1 in
81 for females.
-
8/11/2019 CASE Melanoma Maligna
18/29
Etiology
Genetic Ultraviolet radiation Sunburn Age
-
8/11/2019 CASE Melanoma Maligna
19/29
Precursor Lesion and Risk Factor
Congenital nevi Dysplastic nevi syndrome Spitz nevi Familial patterns
-
8/11/2019 CASE Melanoma Maligna
20/29
-
8/11/2019 CASE Melanoma Maligna
21/29
Staging(American Joint Committee on Cancer TNM Melanoma
Classification 2002)Primary Tumor (T) TX Primary tumor cannot be assessed (e.g., shave biopsy or regressed
melanoma)T0 No evidence of primary tumorTis Melanoma in situT1 Melanoma 1.0 mm in thickness, with or without ulceration T1a Melanoma 1.0 mm in thickness and level II or III, no ulceration T1b Melanoma 1.0 mm in thickness and level IV or V or with ulceration T2 Melanoma 1.01-2.0 mm in thickness, with or without ulcerationT2a Melanoma 1.01-2.0 mm in thickness, no ulcerationT2b Melanoma 1.01-2.0 mm in thickness, with ulcerationT3 Melanoma 2.01-4.0 mm in thickness, with or without ulcerationT3a Melanoma 2.01-4.0 mm in thickness, no ulcerationT3b Melanoma 2.01-4.0 mm in thickness, with ulcerationT4 Melanoma >4.0 mm in thickness, with or without ulceration
T4a Melanoma >4.0 mm in thickness, no ulcerationT4b Melanoma >4.0 mm in thickness, with ulceration
-
8/11/2019 CASE Melanoma Maligna
22/29
Regional Lymph Nodes (N) NX Regional lymph nodes cannot be assessedN0 No regional lymph node metastasis
N1 Metastasis in one lymph nodeN1a Clinically occult (microscopic) metastasisN1b Clinically apparent (macroscopic) metastasisN2 Metastasis in two or three regional nodes or
intralymphatic regional metastasis withoutnodal metastases
N2a Clinically occult (microscopic) metastasisN2b Clinically apparent (macroscopic) metastasis
N2c Satellite or in-transit metastasis without nodalmetastasis
N3 Metastasis in four or more regional nodes,matted metastatic nodes, in-transit metastasis,
or satellites with metastasis in regional node(s)
GROUPING
-
8/11/2019 CASE Melanoma Maligna
23/29
GROUPINGPATHOLOGICSTAGE Tumor Node Metastasis0 Tis N0 M0IA T1a N0 M0
IB T1b N0 M0T2a N0 M0
IIA T2b N0 M0T3a N0 M0
IIB T3b N0 M0T4a N0 M0
IIC T4b N0 M0IIIA T1-4a N1a M0
T1-4a N2a M0IIIB T1-4b N1a M0
T1-4b N2a M0T1-4a N1b M0T1-4a N2b M0T1-4a/b N2c M0
IIIC T1-4b N1b M0T1-4b N2b M0
Any T N3 M0IV Any T Any N M1
-
8/11/2019 CASE Melanoma Maligna
24/29
Therapy
-
8/11/2019 CASE Melanoma Maligna
25/29
Management of Regional Lymph Nodes Monitoring of Patients After Surgical Therapy Surgical Considerations for Metastases
Regional Nodal Recurrence Local and Regional Recurrences Distant Metastases
Systemic Treatment of Melanoma Adjuvant Systemic Therapy
-
8/11/2019 CASE Melanoma Maligna
26/29
Prognostic Factor
-
8/11/2019 CASE Melanoma Maligna
27/29
Ten-Year Survival Rates for Stage I
and II Melanomas STAGE
TUMOR
ULCERATION
T STAGE APPROXIMATE 10-YEAR
SURVIVAL (%)
IA No T1a 90
IB Yes T1b 80
No T2a 80
IIA Yes T2b 65
No T3a 65 IIB Yes T3b 50
No T4a 55
IIC Yes T4b 35
-
8/11/2019 CASE Melanoma Maligna
28/29
Five-Year Survival Rates for Stage IIIMelanoma Patients
STAGE TUMOR
ULCERATION N STAGE APPROXIMATE 5-YEAR
SURVIVAL (%)
IIIA No N1a 70
No N2a 60 IIIB Yes N1a 55
Yes N2a 50
No N1b 55
No N2b 45
IIIC Yes N1b 30
Yes N2b 25
Yes or No N3 30
-
8/11/2019 CASE Melanoma Maligna
29/29
Thank You