Dermal patologic

dr. Muhartono, M.kes, Sp.PA

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 Benign epithelial tumors

1. Seborrheic keratoses
2. Fibroepithelial tumor (skin tag acrochordon,
soft fibroma, fibroma molle)
3. Keratoacanthoma
4. Appendage tumor;
Cylindromas
Syringoma
Trichoepithelioam 6
 1. Seborrheic keratoses
Ins: common, benign, pigmented, basal
keratinocytic proliferation, single/multiple
Age:middle/older/adult
Predileksi;trunk
Ins: male > female
Mac: round, flat, coin plaqmm to cm dark brown,
colortan-black pigmented SK confused
melanoma
Mic:the number of epidermal basal cells is
greately; acantotic; pseudohorny cysts

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 2. Fibroepithelial tumor
Ins: most common of thew cutaneus tumor
Age:midle/older
Predileksi: neck, trunk, face, Intertrigo areas
Mac:soft flesh color, small stalk
Mic: fibrovascular cores covered by squamous
epithel
Biologically : associated: DM, intestinal polyposis
pregnancy

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 3. Keratoacanthoma
Age: >50y of age caucasians
Predilecti: sun exposed skin cheeks nose,
ears, hands
Mac: flesh colored, dome shaped with central
keratinplugcrater, 1cm to sev cm
Mic central keratin filled crater surounded with
proliferating epithelial cells
Berpotensi menjadi ganasepidermoid
karsinoma
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 Dome shaped lesion with central crater
filled with keratin
laki:perempuan=4:1

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 4. Appendage tumor

Cylindromas: lesi:nodules on forehead and

scalp.appear early in life
Mic:appocrine differentiation
Syringoma: lesion of eccrine differentiation
Lesi occur as multiple on the lower eye lids
Trichoepithelioam: hair follikel differentiation
Lesi occur on the face,scalp,neck and upper
trunk

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Premalignant epidermal tumor
Actinic keratosis (solar keratosis)
prior developt malignancy!epidermis
Ac keratosis progresive dysplasia

sun exposure
Keratin ,
other causes: radiation, hydrocarbon,
arsens15
Mutasi p53
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 Actinic keratosis
Mac: diameter lesi <1cm
Red, brownskin color,efl: papule/plaqprod
keratin(keratin horn)
Mic: epidermis (lowermost layer)atypic cells
Basal layer evidence of dyskeratosis with pink
or red cytoplasma
Basal membrane intake
Dermis: thickened, bluegray, elasticfiberselastosis
(abn fiber synt, sun damage fibroblast)
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 Bowens disease
Indolent, scaly, erytematous plaques
Carcinoma insitu
Mic: atypical changes

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 Malignant tumor
1. Squamous cell carcinoma
Most common type
Sun exposed sites, older people
Male. female
Predisposisi fact: sun light, chronic ulcers,
old burns scar, industrial carcinogens (tars
& oils), arsen, radiation
Mucosa (oral cav); tobacco

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 1. Squamous cell carcinoma

Mac: well demarcated, red scalling plaqs,

or nodular, hyperkeratotic ulceration
Mucosal leukoplakia
Mic: epidermal atypia,
Well diufferentiated (with prominent
keratinisasition ) to highly anaplastic with
necrosis and abortive keratinisation

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 2. Basal cell carcinoma

Common, slow growing, very rare metastase

Chronic sun exposure lightly pigmented people
Age: middle >40y
Predileksi; face,head not occur in mucosal
surface
Pattern growth: multifokal(extended)
Nodular (down ward)
Mic: like normal basal layer of the
epidermis(palisading)basal cell proliferating

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 Disorder of pigmentation
Lentigo dont involve proliferation of
melanocyt cel
Ins: all ages (also infancy & childhood)
All sex
No racial predilection
Cause; unknown
Mac: can involve skin &mucosa membrane

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 Lentigo

Mac: 5-10 mm,oval,brown macules

Mic : hyperplasia
melanocytichyperpigmented basal cell
layer in the epidewrmis

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 Pigmented naevus

Mac: congg/acquired
1cm, uniform pigmented
Papules & well defined, rounded borders
Dark brown
Mic:
junctional naevus:naevus cell along the
dermoepidermal junction
Intradermal naevus
Compound naevus: when the melanocyt nest
within both dermis & junctional
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 Dysplastic naevus

Have characteristic features

Mic : compound naevus with architecture
and cytologic evidence of abnormal
growth (atypia)
This type is precursor of malignant
melanoma.

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 Malignant melanoma

Common (relative)deadly
Sun light important role; hereditery?
Lightly pigmented individuhigher risk, than
darkly pigmented (tanning fad?)
Predisp: sunlight
pre existing naevus: eg dysplastic naevus
Mic: melanoma cells (individual) (>naevus cell)
Large nuclei, irregular chromatin, prominent
nuclear

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 Pemeriksaan klinis A=asimetri;
B=border; C=color; D=diameter;
E=levation
Jenis: superficial spreading melanoma;
nodular melanoma; acral lentigo
melanoma

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 Clark levellary dermis
I: intraepidermal
II: in the papil100%
III: papilary-reticularis88%
IV: reticularis66%
V: subcutaneus fat15%

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