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MALIGNANT SKIN

LESIONS

Prof. Dr. Buchari Kasim SpB. SpBP.

Dision of Plastic Surgery North Sumatra University


Skin : ORGAN : 1/6 Body Weight
Skin Loss > 3-6 cm : granulation tissue ulcus

Covering skin/soft tissue loss : basic PLASTIC SURGERY


GRAFT
FLAP
MICROSURGERY
HISTOLOGIC
Str. germinativum BASAL
Sebaceus gland
Sheath of hair follicle CELL
Sweat gland
Growth to surface of skin

Covering skin wound (not deep and not large)

CLINIC : covering every deep & large


skin/soft tissue wound as Recipient
with skin graft or skin flap taken from
donor.
MOST COMMON SKIN MALIGNANT
1.Basal Cell Carcinoma (BASALIOMA)
Types : a. A nodule of ulcer with central creater and rolled smooth

pearly border
b. Morpea type flat without ulceration and poorly defined
borders
c. Cystic type raised and cyst like.
Usually seen on the face or other exposed areas of the body
Commonly slow grow and destroys of local invasion
Rarely metastasize
Surgical excision therapy are the treatments of
choice
WIDE EXCISION + RECONSTRUCTION : GRAFT
FLAP
2. EPIDERMOID OR SQUAMOUS CELL
CARCINOMA
Ulceration with irregular edges
Occurs on exposed areas of the body and in
oral mucous membrane.
More rapid in growth than basal cell carcinoma
Metastasizes lymphnode
Treatment is surgical excision or radiation therapy

WIDE EXCISION + RECONSTRUCTION


+ RADICAL LFN DISECTION
Simplified Tumor Staging For
Squamous Carcinoma of Skin
TNM Classification
T1 2 cm
T2 2 5 cm
T3 > 5 cm
T4 Invading underlying muscle or bone Clinical staging sumary
I T1, N0, M0
M0 No metastatic disease
II T2-3, N0, M0
M1 Distant metastatic disease
III T4, N0, M0 and any T, N1, M0
N0 No nodal involment IV Any T, any N1, M1 (+)
N1 Regional lymph nodes imvolved
G1 Low grade
G2 Moderately
3. Melanoma
The most agressive skin malignancy
Commonly metastasizes early via lymphatics
or blood stream (hematogenic).
Frequently considered a systemic disease
from melanocyte or melanocyte-
related.
Ussually appears as a black slightly raised
non- ulcerative lesion arising from a
preexisting nevus.
Early recognition of changes in color, size or
consistency of a pigmented nevus critical.
Prognose bad/fatally neoplasm tumour.
TYPES SYMPTOMS SPREADING Additional PROGNOSIS
Examination
BASALIOMA Klinis : Local Biopsy : Prognose
(Basal Cell 1. Nodular Slow Surgical or good
Carcinoma) Eksisional
2. Infiltrating
3. Face :
- Periorbital
- Nose
- Ear

SQUAMOUS Ekspose area : Local - Clark Well


CELL Head- faster - TNM differentited
CARCINOMA neck- more Ana Plastic
lower lip Agressive Prognose fair
oral cavity- Metast LFN.
Regional
MELANOMA Age : baby Fast Hyperpigment., Prognose
MALIGNUM old - Lfn itch, ulceration poor
Type : (mm) Expose skin, - Haematogen
Breskow irritation
SURGICAL THERAPY
WIDE EXCISION
1. Direct (GRAFT/FLAP)
+
RECONSTRUCTION 2. Delayed temporarely STSG observe

6 months permanent reconstructive


PA Confirmation
PALLIATIVE ?
PROGNOSE : Recurrency
Morbidity form
Border of Incision
(Surgical Biopsy)
MODERN : Early easy diagnose
NON SURGERY THERAPY :
Suspection Observation/Conservative
- Radiotherapy
2 weeks
- Electrocoagulation
- Chemotherapy regional
BASALIOMA

Wide Excision
Wide Excision
After Wide Excision + Reconstruction
SQUAMOUS CELL CA.
/ ORAL CA.
Wide Excision
+
Reconstruction
Oral Ca. + Fistula
Oral Ca.
PALLIATIVE
CONCLUSION

Diagnose : easy / only inspection + history


Treatment not only wide excision but more
important is reconstruction (Plastic Surgery)
EARLY DIAGNOSE SURGERY !!!!!

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