PEMERIKSAAN FISIK

TUMOR PAYUDARA, KULIT & SOFT TISSUE

Dr. HANTORO ISHARDYANTO., SpB(K)Onk

PEMERIKSAAN KLINIS
1. KELUHAN UTAMA
2. ANAMNESIS :
- RIWAYAT PENYAKIT SEKARANG
( TNM )
- RIWAYAT PENYAKIT DAHULU
- FAKTOR RESIKO
- KOMORBIDITAS

TUMOR
PAYUDARA
1. Anatomi payudara
2. BSE
3. CBE :
- Status
generalis
- Status lokalis
- Status
regionalis

Signs and Symptoms

Most
common:
lump or
thickening in
breast.
Often
painless

Dischar
ge or
bleedin
g
Change in
size or
contours of
breast
15

Redness or
pitting of skin
over the
breast, like the
skin of an
Changeorange
in
color or
appearance
of areola

Status lokalis :
INSPEKSI : - Simetris ? ( Ukuran dan bentuk )
- Kulit payudara :
- warna, massa/tumor, skin
dimple, peaud orange,
venaectasi, borok
- Niple-areolar complex :
- retraksi, discharge,
dermatitis

Status lokalis :
Ada tidaknya massa /
tumor :
1.
2.
3.
4.
5.
6.
7.
8.

lokasi
jumlah
ukuran
konsistensi
batas
permukaan
mobilitas
nyeri tekan

 STATUS REGIONALIS :
1. KGB aksila
2. KGB infra klavikula
3. KGB supra
klavikula
Jumlah,
ukuran,
konsistensi,
mobilitas

BREAST CANCER
Sites of distant
metastases
Brain
Lymph nodes

Pleura

Skin

Lung

Liver

Bone

TUMOR KULIT GANAS

1. MELANOMA MALIGNA
2. NON MELANOMA
MALIGNA :
- BASAL CELL CARCINOMA
- SQUAMOUS CELL
CARCINOMA
- TUMOR ADNEKSA KULIT

'In-transit Metastasis'
in melanoma, a metastatic deposit occurring in the
lymphatic pathway between the primary tumor and its
draining lymph nodes.

In-transit metastasis (in-TRAN-zit mehTAS-tuh-sis)

A type of metastasis in which skin cancer spreads through
a lymph vessel and begins to grow more than 2
centimeters away from the primary tumor but before it
reaches the nearest lymph node.

Satellite metastases
Areas of visible tumor growth extending beyond the
primary melanoma.

Satellite lesions
which are skin or subcutaneous lesions within 2 cm of the
primary tumor that are considered intralymphatic
extensions of the primary mass.
AJCC, 2008

Evolution of Nevi

Evolution of Melanoma

Junctional Nevi

Melanocyte Hyperplasia

Compound Nevi

Dermal Nevi

Dysplastic Nevi

Dysplastic Nevi

Superficial spreading

Klasifikasi Histopatologis
Lentigo Malignant Melanoma
(LMM)
Superficial Spreading Melanoma
(SSM)
Nodular Malignant Melanoma
(NMM)
Acral Lentiginous Melanoma

Lentigo maligna

Nodular melanoma

Clark staging
Based upon histologic level of
invasion
Level I Epidermis only (in situ)
Level II Invades the papillary dermis, but not
to the papillary-reticular interface

Level III Invades to the papillary-reticular

interface, but not into the reticular
dermis

Level IV Into the reticular dermis

Level V Into subcutaneous tissue

Breslow staging
Based upon absolute depth
of invasion
Stage
Stage
Stage
Stage

I < 0.75 mm
II 0.76 1.5 mm
III 1.51 4.0 mm
IV - > 4.0 mm

Charles M. Balch, MD; Seng-Jaw Soong, PhD; Michae ,An Evidence-based Staging System for Cutaneous Melanoma,

AJCC staging

AJCC staging

AJCC staging

Prognosis by AJCC stage

Stage I

< 0.75 96 %
0.75 1.5 87 %

Stage II

1.5 2.49 75 %
2.5 3.99 66 %
> 4.0 47 %

Stage III

One node 45 %
Two nodes < 20 %

Stage IV

8 10 %

Percentages are five year survival except stage IV lesions

which represent one year survival

BASAL CELL CARCINOMA

NEVUS TAMBAH BESAR GATAL
GARUK LUKA TAMBAH BESAR
RAPUH DAN MUDAH BERDARAH.
ULKUS RODENT
LOCAL DESTRUCTIVE
SERING PADA WAJAH ( LOKASI YG
TEREKSPOSE SINAR MATAHARI)
SANGAT JARANG BER METASTASIS

SQUAMOUS CELL
CARCINOMA
1. LUKA BAKAR
2. IRITASI KRONIS
3. MARJOLINE ULCERS
4. SEPERTI BUNGA KOL
5. RAPUH, MUDAH
BERDARAH
6. SERING DI
EKSTREMITAS
7. BER METASTASIS (+)

TUMOR GANAS JARINGAN LUNAK

KLINIS
Metastasis 4 11% kasus tumor ganas jaringan lunak :
Paru 34%
Hepar 25%
Tulang 23%
SSP 3%

Umumnya secara hematogen

Limfogen hanya 5%, paling sering terjadi pada jenis
histologi tertentu yaitu
Synovial sarcoma
Myxoid liposarcoma
Rhabdomyosarcoma, tipe alveoler.

High grade > 50%

Low grade < 15%

Sifat tumor ganas jaringan

lunak
Ditentukan oleh :
Grading tumor
Ada sistem :
2 grade ( low and high grade)
3 grade ( low.intermediate and high )
4 grade :
Well differentiated
Moderately differentiated
Poorly differentiated
undifferentiated

Lokasi tumor
Ukuran tumor
Histopatologi tumor

ENNEKING
CLASSIFICATIO
N FOR
SURGICAL
PROCEDURES
ON STS
ACCORDING TO
THE MARGINS
ACHIEVED
LR
6080%

LOWEST
LR

LR
30%
LR
100%

Eksisi yang dapat dilakukan :

Eksisi wide margin yaitu 1 cm diluar
zona reaktif.
Eksisi marginal margin yaitu pada
batas pseudo capsul.
Eksisi intralesional margin yaitu
memotong parenchim tumor atau de
bulking, dengan syarat :
harus membuang massa tumor > 50%
tumornya harus berespon terhadap
radioterapi atau khemoterapi.

TERIMAKASIH