CASE Melanoma Maligna

8/11/2019 CASE Melanoma Maligna

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CASE REPORT

MELANOMA MALIGNA

SEKAR KAMULYAN HOSPITAL

CIGUGUR-KUNINGAN

2014

Raisa Yohana Miharja (0915081)Vania Azalia Hariyanto (0915100)Sahala Triyanto Simamora (0815129)

Budyatmoko Gondo Suryoko (0715146)Fransiskus Balpon (0515178)

Preceptor:dr. Antonius K, SpB, FInaCS


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Patient Identity

Name : Mr. D Age : 60 y.o Admission Date : June 18 th , 2014 Room/ Ident.no : Elisa/ 162879 Sex : Men Address : Tegaleja


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History Taking

Autoanamnesis and heteroanamnesis (daughter) Chief complaint: pain on the left sole Pain on the left sole for about one year. Three years

before, there was a black flat round lesion as big as

bean, with irregular border, pain (-), bleeding (-), pus (-),getting bigger to as big as tennis table ball, a little bitprotruding, there was a wound but no bleeding, itching(-), pain (+) especially when walking.


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Physical Examination General state : good

Pain status : moderate Awareness : compos mentis Nutritional status : good

Vital sign

Blood pressure : 120/70 mmHg Heart rate : 68 x/minute Respiration : 18 x/minute Temperature : 36,6 oC


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Skin : icteric (-), anemic (-), cyanosis (-) Head : anemic conjungtiva -/-, icteric sclera -/-, round

isocor pupil, d 3mm, pupillary reflex +/+ Neck : No palpable lymph node Thorax :

Cor : S1, S2, regular, murmur (-) Pulmo : VBS +/+, Rh -/-, Wh -/-

Abdomen : flat, BS (+) normal, tympanic, tenderness (-) Inguinal : palpable left inguinal lymph node, d 3 cm, soft,

flat, immobile, pain (-) Extremity : warm , CRT < 2

a/r left sole : black round lesion, d 4 cm, irregular border, alittle bit protruding, ulcus (+), blood (-), pus (-). Anus & rectum : in normal range


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Differential Diagnosis

Melanoma maligna a/r left sole Ulcus decubitus a/r left sole


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Working Diagnosis

Melanoma maligna a/r left sole


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Management

Wide and deep excision on June 19 th , 2014 13.00 D/ pre op : Melanoma maligna suspect a/r left sole D/ post op : Melanoma maligna suspect a/r left sole


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Post operation instruction

TTV monitoring Fasting : until fully awake IV line : Futrolit 20 gtt/minute Medication : Ceftriaxone vial 1gr 2x1 IV

Toramin 3x1 amp IV


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Prognosis

Quo ad vitam: dubia ad bonam Quo ad functionam: dubia ad malam


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Melanoma Maligna


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Definition

Malignant melanoma is a neoplasm of melanocytes.Although it was once considered uncommon, the annualincidence has increased dramatically over the past fewdecades.


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Epidemiology Whites > Asian and black populations (20x). Men > women, the prognosis is slightly better for women. Arise more commonly on the lower extremity in women and more often on

the trunk and head and neck in men. Can occur at any age, the median age at diagnosis is in the range of 45 to 55

years. Accounts for only 4-5% of all skin cancers but causes the majority of deaths

from skin malignancies. The eighth most common cancer in the United States. Estimated: 62,190 new cases diagnosed and 7910 deaths in 2006. The lifetime probability of melanoma developing is 1 in 57 for males and 1 in

81 for females.


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Etiology

Genetic Ultraviolet radiation Sunburn Age


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Precursor Lesion and Risk Factor

Congenital nevi Dysplastic nevi syndrome Spitz nevi Familial patterns


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Staging(American Joint Committee on Cancer TNM Melanoma

Classification 2002)Primary Tumor (T) TX Primary tumor cannot be assessed (e.g., shave biopsy or regressed

melanoma)T0 No evidence of primary tumorTis Melanoma in situT1 Melanoma 1.0 mm in thickness, with or without ulceration T1a Melanoma 1.0 mm in thickness and level II or III, no ulceration T1b Melanoma 1.0 mm in thickness and level IV or V or with ulceration T2 Melanoma 1.01-2.0 mm in thickness, with or without ulcerationT2a Melanoma 1.01-2.0 mm in thickness, no ulcerationT2b Melanoma 1.01-2.0 mm in thickness, with ulcerationT3 Melanoma 2.01-4.0 mm in thickness, with or without ulcerationT3a Melanoma 2.01-4.0 mm in thickness, no ulcerationT3b Melanoma 2.01-4.0 mm in thickness, with ulcerationT4 Melanoma >4.0 mm in thickness, with or without ulceration

T4a Melanoma >4.0 mm in thickness, no ulcerationT4b Melanoma >4.0 mm in thickness, with ulceration


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Regional Lymph Nodes (N) NX Regional lymph nodes cannot be assessedN0 No regional lymph node metastasis

N1 Metastasis in one lymph nodeN1a Clinically occult (microscopic) metastasisN1b Clinically apparent (macroscopic) metastasisN2 Metastasis in two or three regional nodes or

intralymphatic regional metastasis withoutnodal metastases

N2a Clinically occult (microscopic) metastasisN2b Clinically apparent (macroscopic) metastasis

N2c Satellite or in-transit metastasis without nodalmetastasis

N3 Metastasis in four or more regional nodes,matted metastatic nodes, in-transit metastasis,

or satellites with metastasis in regional node(s)

GROUPING


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GROUPINGPATHOLOGICSTAGE Tumor Node Metastasis0 Tis N0 M0IA T1a N0 M0

IB T1b N0 M0T2a N0 M0

IIA T2b N0 M0T3a N0 M0

IIB T3b N0 M0T4a N0 M0

IIC T4b N0 M0IIIA T1-4a N1a M0

T1-4a N2a M0IIIB T1-4b N1a M0

T1-4b N2a M0T1-4a N1b M0T1-4a N2b M0T1-4a/b N2c M0

IIIC T1-4b N1b M0T1-4b N2b M0

Any T N3 M0IV Any T Any N M1


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Therapy


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Management of Regional Lymph Nodes Monitoring of Patients After Surgical Therapy Surgical Considerations for Metastases

Regional Nodal Recurrence Local and Regional Recurrences Distant Metastases

Systemic Treatment of Melanoma Adjuvant Systemic Therapy


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Prognostic Factor


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Ten-Year Survival Rates for Stage I

and II Melanomas STAGE

TUMOR

ULCERATION

T STAGE APPROXIMATE 10-YEAR

SURVIVAL (%)

IA No T1a 90

IB Yes T1b 80

No T2a 80

IIA Yes T2b 65

No T3a 65 IIB Yes T3b 50

No T4a 55

IIC Yes T4b 35


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Five-Year Survival Rates for Stage IIIMelanoma Patients

STAGE TUMOR

ULCERATION N STAGE APPROXIMATE 5-YEAR

SURVIVAL (%)

IIIA No N1a 70

No N2a 60 IIIB Yes N1a 55

Yes N2a 50

No N1b 55

No N2b 45

IIIC Yes N1b 30

Yes N2b 25

Yes or No N3 30


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Thank You

Documents

CASE Melanoma Maligna