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Pre-Cancer and Cancer

RASITA ZAHRINA – 406151027

PEMBIMBING : DR. MARIA DWIKARYA, SP.KK

KEPANITERAAN KLINIK KULIT UNTAR JANUARI 2017

Paget’s 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

dan daerah perianal atau terdapat tinea cruris kronik  Lesi: mirip seperti dermatitis. lipat paha. krusta  Gejala awal: sangat gatal  ekskoriasis dan likenifikasi  DD : karsinoma sel basal. bowen disease. candidiasis cutaneus. lichen simplek kronik. dermatitis kontak iritan. tinea cruris . eritem. Penyebab utama ???  Kemungkinan EMPD harus di pikirkan jika ada dermatitis kronik di vulva.

mostly in single units.Pemeriksaan yang di anjurkan:  Biopsi kulit  Pemeriksaan KGB  Wanita : pemeriksaan pelvic (test papanicolaou). 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. pemeriksaan payudara. 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 .

(B) Relatively well defined whitish depigmented patches on the imiquimod application sites after 3 months.(A) Extramammary Paget's disease lesions around pubic area. .

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Clinical aspect of extensive extramammary invasive Pagetæs disease with involvement of groins scrotum and perineum .

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etc. the exact cause for the condition is still being researched upon  If the painless nodule bothers a woman. 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. she might opt for treatment of the condition. 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.). Vulvar Syringoma  Syringoma of Vulva is a benign skin tumor of a type of sweat gland (known as the eccrine sweat glands. the nodule is removed by surgery. However. the prognosis for Vulvar Syringoma is reported to be excellent . With suitable treatment. most women with the condition do not need treatment  When treatment is warranted or opted for.

The tumor is also commonly present during puberty  Women of all racial and ethnic background may be affected. Faktor Risiko  Although Syringoma of Vulva could occur at any age. it is normally seen in young adults. 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 . however.

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. it must be stated that the condition is non- infectious. 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. They are mostly well- demarcated and firm to touch .

such as basal cell carcinoma and eccrine hidrocystoma of skin. hence. should be ruled out. the healthcare provider examines the skin using ultraviolet light. 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  Wood’s lamp examination: In this procedure. biopsy is an important diagnostic tool . 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.

However. a complete surgical excision cures the condition  Once the tumor is completely removed. unless it becomes bothersome  When required or opted for. removal of the nodule is not necessary. it usually does not recur. 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 . Tatalaksana  In a majority of cases.

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rectum. vagina. dan saluran kencing  Berhubungan dengan SCC. 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 . kunikulatum epitel. Giant Condyloma  Merupakan plak berjonjot destruktif lokal yang tumbuh lambat tapi jarang bermetastase  Sering ditemukan pada glans penis. Daerah lain: vulva. scrotum.

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 .

podofilin. etretinate. mitomycin-C dan 5-fluorourasil. atau interferon Terapi sistemik: imiquimod (jika tumor positif HPV- 6).Perbedaan dengan kondiloma akuminata biasa: stratum korneum lebih tebal dan keberadaan endofit yang menurun serta kemungkinan untuk menginvasi lebih dalam Terapi topikal : 5-fluorourasil. antibiotik untuk infeksi sekunder .