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Melanoma Maligna

Definisi ::
1. Neoplasma malignan berasal dari tranformasi
malignan melanosit pada dermal-epidermal
junction atau dari nevomelanosit nevi
melanotik atipikal atau CNMN dan
mengalami metasetasis dalam berbagai
interval waktu
2. Tumor kulit yang paling ganas, jarang

Epidemiologi ::
1. American Cancer Society :: thn 2006 tdp 111. 900
kasus baru melanoma; 49.710 in situ & 62.190 invasif
2. US Survaillance, Epidemiology, and End Result
Programs :: survival rate utk melanoma 60% 19601963, 80% 1974-76, 89% 1992-1997
3. Rerata usia diagnosis 52 tahun
4. Usia < 40 tahun :: insiden >>
5. Usia > 40 tahun :: insiden >>

Faktor Risiko ::

Klasifikasi ::
De novo ::
1.
2.
3.
4.
5.
6.
7.

Melanoma in situ (MIS)


Lentigo maligna melanoma
Superfisial spreading melanoma
Nodular melanoma
Acral-lentigenous melanoma
Melanoma of mucous membrane
Desmoplactic melanoma

Melanoma arising from precusor ::


1. In atypical nevomelanotic nevi
2. In congenital nevomelanotic nevi

Gambaran Klinis ::
Lesion with irregular
borders & irregular
pigmentation, subtly
as discreta focal area
of darkening within
pre-existing nevus

Gambaran Klinis ::
Superficial spreading melanoma (SSM)
1. Superficial spreading melanoma (SSM) sub tipe
>>>
2. Hampir 70% kasus melanoma kutaneus
3. Usia dekade 4 & 5 :: intermitten sun exposed areas
4. Predileksi punggung bagian bawah & ekstremitas
bawah

Diagnosis Banding SSM ::

Nodular melanoma (NM) ::


1. Tipe terbanyak kedua
2. 15% - 30% kasus melanoma
3. Rerata usia onset 53 tahun
4. Predileksi plb byk trunkus
5. NM tipikal uniformly dark blue-black
or bluis-red raised lesion, 5% amelanotic
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Diagnosis Banding NM ::

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Lentigo melanoma maligna ::


1. Frekuensi 5% semua kasus melanoma
2. Predileksi wajah, leher, lengan bawah &
dorsum manus
3. Selalu dimulai dengan lentigo maligna
4. Lesi neoplasma intraepidermal (makula/plak
hiperpigmentasi), papular fokal, nodular
mengalami fase pertumbuhan vertikel dan
invasi ke dermis
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Diagnosis Banding LMM ::

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Acral lentigenous melanoma ::


1.
2.
3.
4.
5.

5-10% kasus melanoma


Predileksi palmar, plantar & subungual
Rerata onset 65 tahun
> ; 3 : 1
Byk dilaporkan pd black American & Japanese
brown-skinned person
6. Lesi : makula, papul, nodul
hiperpigmentasi,variasi wrn coklat, hitam, biru,
batas ireguler
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Lesi subungual ::
1.makula subungual pada nail matrix, menyebar
ke nail bed & nail plate
2.Papul, nodul & destruksi nail plate
3.Wrn coklat tua-hitam seluruh nail plate
4.Fase pertumbuhan tumor, kuku terlepas

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Diagnosis Banding ALM ::

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Imunohistokimia ::
1. Useful for diagnosis melanoma especially inpoorly
differentiated neoplasma with litle or no pigment ( i,e
amelanotic melanomas), spindle cell tumors or tumor
with pagetoid spread that are not obviosly melanoma
2. S100 protein expressed virtually all melanoma,
melanocytic nevi, langerhans cell, cutaneous neural
tumors
3. HMB 45 monoclonal antibody with high specificity
for melanoma
4. Melan-A & MART-1(melanoma recognized by T-cell)
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Melanoma TNM Classification ::

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Pengobatan ::
1. Surgery wider excision (WLE) prevent
local recurrence to confirm tumor free
margin, inadequat excision potential lethal
2. Treatment regional metastasis complete
lymph node dissection (CLND)
3. Adjuvant therapyinterferon- 2b high
doses

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1. Immunotherapy high dose bolus interleukin


2 (IL-2)
2. Biochemotherapy vaccine combination
other systemic agent (dacarbazine or IL-2)
3. Melanoma Vaccine autologous,allogeneic,
peptide vaccines unfortunately without
significant progress

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Pencegahan ::
1. Safe sun exposurelimited UV exposure & sun
burn prevention especially childhood &
adolescent have risk is greatest
2. Avoidance peak sunlight hours
3. Use wide-brimmed hats
4. Clothing & sunscreen recommended
5. Early diagnosis & knowledge early signs &
symptoms of melanoma reduced morbidity &
mortality
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