Dermal patologic

dr. Muhartono, M.kes, Sp.PA

Benign epithelial tumors

1. Seborrheic keratoses
2. Fibroepithelial tumor (skin tag
acrochordon, soft fibroma, fibroma
molle)
3. Keratoacanthoma
4. Appendage tumor

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: multifoka l(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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