Oleh:Aries Rahman Hakim, S.Ked082011101017
Pembimbing:dr. Gunawan Hostiadi, Sp.KK
SMF KULIT DAN KELAMIN RSD DR. SOEBANDI JEMBRFAKULTAS KEDOKTERAN UNIVERSITAS JEMBER2012
MELANOMA MALIGNA
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Adalah suatu keganasan yang terjadi pada sel melanosit
dEFINISI
Stratum Korneum
Stratum Lusidum
Stratum Granulosum Stratum Spinosum
Stratum Basale
Melanosit
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• Di Amerika tahun 2008 dilaporkan sebesar 62.480 kasus.• Pada tahun 1930 resiko melanoma maligna 1:11.500,tahun
2000 1:74• Laki-laki : perempuan = 0.97:1
Epidemiologi
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• Nevus• Riwayat Keluarga• Pajanan sinar UV yang berlebihan• Usia• Supresi sistem imun
Faktor Resiko
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• Belum diketahui dengan jelas • Multifaktor • Terjadinya mutasi genetik melalui percepatan
terhadap proliferasi, diferensiasi dan kematianserta pengaruh efek karsinogenik radiasiultraviolet.
Patofisiologi
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Manifestasi klinis
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Stage TNM Classification Histologic/Clinical Features
0 Tis N0 M0 Intraepithelial/in situ melanoma
IA T1a N0 M0 ≤1 mm without ulceration and level II/III
IB T1b N0 M0
T2a N0 M0
≤1 mm with ulceration or level IV/V
1.01-2 mm without ulceration
IIA T2b N0 M0
T3a N0 M0
1.01-2 mm with ulceration
2.01-4 mm without ulceration
IIB T3b N0 M0
T4a N0 M0
2.01-4 mm with ulceration
>4 mm without ulceration
IIC T4b N0 M0 >4 mm with ulceration
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IIIA T1-4a N1a M0
T1-4a N2a M0
Single regional nodal micrometastasis, nonulcerated primary
2-3 microscopic positive regional nodes, nonulcerated primary
IIIB T1-4bN1a M0
T1-4bN2a M0
T1-4a N1b M0
T1-4a N2b M0
T1-4a/b N2c M0
Single regional nodal micrometastasis, ulcerated primary
2-3 microscopic regional nodes, nonulcerated primary
Single regional nodal macrometastasis, nonulcerated primary
2-3 macroscopic regional nodes, no ulceration of primary
In-transit met(s)* and/or satellite lesion(s) without metastatic lymph nodes
IIIC T1-4b N2a M0
T1-4b N2b M0
Any T N3 M0
Single macroscopic regional node, ulcerated primary
2-3 macroscopic metastatic regional nodes, ulcerated primary
4 or more metastatic nodes, matted nodes/gross extracapsular extension, or in-
transit met(s)/satellite lesion(s) and metastatic nodes
IV Any T any N M1a
Any T any N M1b
Any T any N M1c
Distant skin, subcutaneous, or nodal mets with normal LDH levels
Lung mets with normal LDH
All other visceral mets with normal LDH or any distant mets with elevated LDH
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Diagnosis
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Differensial diagnosis
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Penatalaksanaan
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Stage Survival rate selama 5 tahun
Stage I dan II (≤1mm) sebesar 91-95%, (1,01-4mm) sebesar 63-89%, (>4mm) sebesar 67% ulserasi -, dan 45%
ulserasi +.
Stage III Metastase lymphonodi sebesar 13-69%, Pada lesi satelit sebesar 30-50%.
Stage IV Median survival hanya 6-9 bulan dan ketahanan hidup selama 5 tahun sekitar 7-19%
Prognosis
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Laporan Kasus
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Superficial Spreading Melanoma
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TERIMAKASIH
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