Pre-Cancer and Cancer

RASITA ZAHRINA 406151027

PEMBIMBING : DR. MARIA DWIKARYA, SP.KK

KEPANITERAAN KLINIK KULIT UNTAR JANUARI 2017

 Pagets Disease

Merupakan suatu bentuk kanker payudara yang jarang

terjadi.
Extramammary PD timbul sebagai adenokarsinoma
cutaneus primer.
Menyerang kulit genital, perianal atau daerah lain yang
kaya akan kelenjar apokrin
Epidermis terinfiltrasi oleh sel neoplastic yang berasal dari
kelenjar apokrin atau stem sel keratinositik
Tumor yang paling sering berhubungan: karsinoma
apokrin adneksa
 Penyebab utama ???
Kemungkinan EMPD harus di pikirkan jika ada dermatitis
kronik di vulva, lipat paha, dan daerah perianal atau
terdapat tinea cruris kronik
Lesi: mirip seperti dermatitis, eritem, krusta
Gejala awal: sangat gatal ekskoriasis dan likenifikasi
DD : karsinoma sel basal, bowen disease, candidiasis
cutaneus, dermatitis kontak iritan, lichen simplek kronik,
tinea cruris
Pemeriksaan yang di anjurkan:
Biopsi kulit
Pemeriksaan KGB
Wanita : pemeriksaan pelvic (test papanicolaou), pemeriksaan
payudara, dan colposcopy

Photomicrograph of malignant
melanoma in situ of skin displays
prominent intraepidermal
pagetoid spread. Note that
melanoma cells are present in all
layers of epidermis, mostly in
single units. Cytoplasm of
melanoma cells is vacuolated.
Moderate upper dermal chronic
inflammatory infiltrate is present
Sel Paget : sel vakuolisasi besar yang memiliki
sitoplasma kebiruan yang menginfiltrasi epidermis
Sel paget dapat ditandai dengan sialomusin dengan
menggunakan PAS (Periodic Acid-Schiff)
Cytokeratin 20 (CK 20) dan BRST-2 : positif pada
EMPD primer dan sekunder
Treatment: imiquimod 5% cream 3 x/minggu selama
16 minggu (imunomodulator), 5-fluorourasil
Gold standard: Mohs micrographic surgery
(A) Extramammary Paget's disease lesions around pubic area. (B) Relatively
well defined whitish depigmented patches on the imiquimod application sites
after 3 months.
Clinical aspect of extensive extramammary invasive
Pagets disease with involvement of groins scrotum
and perineum
 Vulvar Syringoma
Syringoma of Vulva is a benign skin tumor of a type of sweat gland
(known as the eccrine sweat glands; the other types of sweat glands are
apocrine and sebaceous) of the female reproductive part known as the
vulva
This kind of tumor is relatively widespread and presents as a painless
nodule. The condition is common in young adult women
Although some risk factors have been reported for Vulvar Syringoma
(such as uncontrolled diabetes, a family history of the condition, etc.), the
exact cause for the condition is still being researched upon
If the painless nodule bothers a woman, she might opt for treatment of
the condition. However, most women with the condition do not need
treatment
When treatment is warranted or opted for, the nodule is removed by
surgery. With suitable treatment, the prognosis for Vulvar Syringoma is
reported to be excellent
 Faktor Risiko
Although Syringoma of Vulva could occur at any age, it is
normally seen in young adults. The tumor is also commonly
present during puberty
Women of all racial and ethnic background may be affected;
however, the prevalence of Vulvar Syringoma is higher in
women of Asian descent and women with darker skin
The risk factors for Syringoma of Vulva include the following:
A positive family history of Vulvar Syringoma
Individuals with Down syndrome
Having a poorly-controlled diabetes
 Etiologi dan Gejala Klinis
The exact cause of development of Syringoma of Vulva is
unknown and research is underway to identify relevant causal
factors
However, it must be stated that the condition is non-
infectious. Vulvar Syringoma is not caused by sexual
transmission (or by direct physical contact) from one
individual to another
The signs and symptoms of Syringoma of Vulva may include:
Syringoma of Vulva typically occurs as a single, raised nodule on the skin
of the vulva
It can range in size from a few millimeters to a centimeter
The skin over the nodules may have a reddish discoloration
The nodule is usually painless and non-itchy. They are mostly well-
demarcated and firm to touch
 Diagnosis

A healthcare provider may require the following to

diagnose Syringoma of Vulva:
A thorough medical history and physical examination
Dermoscopy: It is a diagnostic tool where a dermatologist
examines the skin using a special magnified lens
Woods lamp examination: In this procedure, the healthcare
provider examines the skin using ultraviolet light. It is performed
to examine the change in skin pigmentation
Skin biopsy: A skin biopsy is performed and sent to a laboratory
for a pathological examination
Differential diagnosis of other tumors, such as basal cell carcinoma
and eccrine hidrocystoma of skin, should be ruled out; hence,
biopsy is an important diagnostic tool
 Tatalaksana

In a majority of cases, removal of the nodule is not

necessary, unless it becomes bothersome
When required or opted for, a complete surgical excision
cures the condition
Once the tumor is completely removed, it usually does not
recur. However, an incomplete removal may result in a
recurrence
Cauterization (burning-off) of the tumor using a CO2 laser
is an alternative to surgical removal of the tumor
 Giant Condyloma

Merupakan plak berjonjot destruktif lokal yang tumbuh lambat

tapi jarang bermetastase
Sering ditemukan pada glans penis. Daerah lain: vulva, vagina,
rectum, scrotum, dan saluran kencing
Berhubungan dengan SCC, kunikulatum epitel, dan
papilomatosis florid oral
GCBL berawal di preputium sebagai plak keratotik dan meluas
jadi massa cauliflowerlike
Pertumbuhan tumor mencapai 20 tahun
Lesi bisa menjadi ulcer atau membentuk penile horn dan
biasanya berbau
Pembesaran KGB terjadi karena infeksi sekunder bukan
metastase
 Faktor Risiko dan DD

Laki-laki tidak di sirkumsisi

Fimosis kronik
Higiene penis yang buruk
Iritasi kronik: fistula perianal dan ulcerative colitis
Penggunaan kontrasepsi oral
Terdapat penyakit STD lainnya
DD : rectal adenocarcinoma, limfangioma, lesi
hiperplastik
Perbedaan dengan kondiloma akuminata biasa:
stratum korneum lebih tebal dan keberadaan endofit
yang menurun serta kemungkinan untuk menginvasi
lebih dalam
Terapi topikal : 5-fluorourasil, podofilin, atau
interferon
Terapi sistemik: imiquimod (jika tumor positif HPV-
6), mitomycin-C dan 5-fluorourasil, etretinate,
antibiotik untuk infeksi sekunder