Alfa Sylvestris
Jinak
A. Primer
Ganas
Jinak
TUMOR
B.
Sekunder
Ganas
C. Metastase
2
Retinoblastoma
Retinoblastoma is a disease that
causes the growth of malignant
tumors in the retinal cell layer of
the eye.
It is the most common eye tumor
in children (<5 yo)
3
unilateral / bilateral
extraocular:
- through sclera
orbital cavity proptosis
through N.II intra
cranial
Symptoms of Retinoblastoma
Problems with eye
movements
(crossed eyes).
A persistent red
irritation in the
eye.
Differences in pupil
size, iris color,
abnormal eye
movements,
bulging forward of
the eyes, tearing,
A white spot on
the pupil of the
eye. cats eye
Visual disturbance
Sign :
- VA
- Leucocoria
- Strabismus
- Glaucoma
- Tumor mass in the vitreous with
calcification
Additional exam
X Photo Ro
USG B scan
CT Scan
PA durante op
Lactic Dehidrogenase enzyme (LDH) in
humour aqeous paracintesa
(compared with level serum)
- Specific skin test for retinoblastoma
using crude
membrane extracts of retinoblastoma
cells
developed in tissue culture.
- Tapping paracintesa for tumour cells
9
in
-
Diagnosis
Untreated, Retinoblastoma is almost
always fatal.
Early examination is key to survival.
Treatments
Chemotherapy
Cryotherapy (freezing treatment)
Enucleation ( removal of the eye)
External beam radiation therapy (radiation
treatment)
Localized plaque radiation therapy
(radiation therapy)
Photocoagulation (laser treatment)
Prognosis
The survival rate for Retinoblastoma
patients is more than 90%.
This is attributed to earlier diagnosis
and improved methods of treatment.
SQUAMOUS CELL
CARCINOMA
SCC keganasan ke-2 terbanyak pd
kelopak mata (9%)
US 105 kasus tiap 100.000 penduduk
Australia 166 kasus tiap 100.000
penduduk
SCC kelopak mata > conjungtiva
Invasi ke bola mata, struktur orbita,
lymphe node regional, metastese jauh
diagnosa awal sangat penting !
ETIOLOGI
Paparan sinar matahari kronis
Usia tua (60-70 th)
Orang muda dengan imunitas
(radioterapi, HIV)
Human papilloma virus pd pasien HIV
Zat kimia (minyak, tar, asap rokok,
arsenik, parafin)
Dermatosis prekanker
Pria (75%) > wanita (25%)
DIAGNOSIS KLINIS
Pemeriksaan lain :
Hertel exophthalmometri
Palpasi lymphe node regional
Tes faal hepar
Analisa genetis untuk xeroderma
pigmentosum
Tes HIV
CTscan
Grade
Grade
Grade
Grade
1:
2:
3:
4:
HISTOPATOLOGI
Sarang-sarang sel masuk ke dermis
disertai reaksi inflamasi kronis
Keratinisasi pada well differentiated
Undifferentiated sitoplasma eosinofilik,
mutiara keratin, jembatan interseluler
STADIUM KLINIS
T0
T1
T2
T3
T4
lesi in situ
diameter < 2 cm
diameter 2-4 cm
diameter > 4 cm
invasif pada tulang dan otot
TERAPI
PEMBEDAHAN
Bedah eksisi dengan :
Tehnik Mohs
Vriescope
Diikuti dengan bedah rekonstruksi
Kadang diperlukan eksenterasi orbita dan
eksisi en bloc bila telah melibatkan tulang
RADIOTERAPI
Bila ada KI bedah atau menolak operasi
SCC lebih resisten dosis lebih
Kelemahan :
Tepi tidak terkontrol
Komplikasi post radiasi
Kunjungan berulang kali
Tidak dapat :area yang pernah
diradiasi, tumor di tengah kelopak,
usia < 40 th, xeroderma
pigmentosum
CRYOTERAPI
Kelebihan : biaya, nyaman, potensiasi
kataraktogenik , dapat diulang
Tidak dapat : tumor terfiksasi di
periosteum, pada canthus medialis,
diameter >10 mm, lesi tidak jelas
tepinya, lesi melebihi conjungtiva fornix
Nitrogen cair semprot dengan
melindungi bola mata
ES depigmentasi, bulu mata hilang,
hipertrofi scar, ektropion, epifora,
hiperplasia pseudoepitelomatous
KEMOTERAPI
Sebagai terapi tambahan untuk SCC
kelopak mata lanjut
Cisplatin, atau kombinasi dengan
doxorubicin, bleomycin, isotretinoin, interferon
FOLLOW UP
Curiga SCC kelopak mata evaluasi 6-12
bulan
Telah mengenai lymph node 2-3 bulan
selama 2 th pertama
PENCEGAHAN
Sunscreen SPF 15 wajah dan kelopak mata
bawah, dan dioleskan tipis-tipis pada
kelopak mata atas dan dahi
Pakaian dan topi pelindung
Menghindari paparan sinar matahari pk.
10.00-15.00 WIB sore
Menurunkan 78%
Nodulo-ulcerative BCC
shinny, firm, pearly nodule,
small dillated blood vessel on
its surface
growth slow central
ulceration, raised rolled edges
(rodent ulcer)
Sclerosing BCC
difficult to dx infiltrates
laterally beneath the epidermis
plaque
palpation better than
inspection to determine the
tumor.
Treatment
Surgical excision remove the entire tumour but
preserve as much normal tissue as possible
together with 4 mm margin tissue which looks
clinically normal
large tumour frozen section or Moh
micrographic surgery
Reconstruction the defects
Radiotheraphy for nodulo-ulcerative BCC with
no involvement of medial canthal area and
unsuitable for/refuse surgery
Treatment
Cryotheraphy small superficial
BCC
Laser microsurgery wellcircumscribed BCC of the lid margin
without conjunctival extention
MELANOMA MALIGNA
ORIGIN :
- arising from PAM (primary acquired
melanosis) with atypia 75 %
- arising from a pre existing naevus 20 %
- primary melanomais the least common
6th decade
Signs MM conjunctiva :
A solitary, black or grey nodule containing
dilated feeder vessels which may become
fixed to the sclera
Amelanotic tumours are pink, smooth, fishflesh app.
A common site is the limbus (may arise
everywhere)
Therapy :
Circumscribe melanoma
wide excision with clearence and cryotherapy to
prevent reccurence
incomlete clearence + re excision and
cryotherapy
follow up every 6-12 monthly suspicious
area biopsy and impression citology
Diffuse melanoma excision and cryotherapy or
mitomicin C
Orbital recurences local resection and
raadiotherapy
Lymph node involve excision and radiotherapy
Palliation chemotherapy for metastatic disease
Prognosis
5 ysr 12 %
10 ysr 25 %
Metastase : regional lymph nodes,
lung, brain, liver
Signs MM eyelid :
Rare, but lethal
Superficial spreading melanoma plaque
with an irregular outline and variable
pigmentation
Nodular melanoma blue-black nodule
surrounded by normal skin
Melanoma arisin gfrom lentigo maligna
(slowly expanding pigmented macule in
elderly Hutchinson freckle)
Anterior uveitis
Annular/ circumferential growth
360- worst prognosis e.c difficulty
to diagnose
Diagnostic
Triple mirror contact lens
Transillumination for amelanotic
melanoma
USG
Biopsy
Therapy
Enucleation large tumour and
affecting the anterior choroid,
secondary glaucoma
Iridocyclectomy small medium
tumours involving less than one third
of the angle
Radiotherapy
Signs MM choroid :
Sixth decade of life
Decrease VA or VF defect
Third patients very brief balls of light
traveling across the visual field two-three
times a day in the subdued lighting
Elevated subretina, dome shaped, brown
or grey mass, mottled with dark brown/
black pigment/ amelanotic.
Mushroom shape app if breaks through
Brunch membrane
Secondary exudative RD
Choroidal folds, haemmorrhage,
secondary glaucoma, cataract, and
uveitis
Diagnosis
TREATMENTS
Brachytherapy tumours < 10 mm in
elevation and < 20 mm in basal dia.
External radiotherapy more posterior (>
4 mm of the disc)
Transpupillary thermotherapy (w/ diode
laser) small tumours, location near the
fovea or optic disc
Trans scleral local resection = excision
tumours with the rim of healthy choroid
under a partial thickness scleral flap too
thick for radiotherapy, < 16 mm in dia.