Slide 1
TUMOR GANAS MATAAlfa Sylvestris
TUMOR
A. Primer B. SekunderC. Metastase
JinakGanasJinakGanas2
Retinoblastoma3
Retinoblastoma is a disease that causes the growth of malignant
tumors in the retinal cell layer of the eye. It is the most common
eye tumor in children ( conjungtivaInvasi ke bola mata, struktur
orbita, lymphe node regional, metastese jauh diagnosa awal sangat
penting !
ETIOLOGIPaparan sinar matahari kronisUsia tua (60-70 th)Orang
muda dengan imunitas (radioterapi, HIV)Human papilloma virus pd
pasien HIVZat kimia (minyak, tar, asap rokok, arsenik,
parafin)Dermatosis prekanker Pria (75%) > wanita (25%)
DIAGNOSIS KLINISRiwayat kelainan dan keganasan kulitStatus imun
penderitaRiwayat paparan UVRiwayat paparan zat kimiaRiwayat lesi
jinak kelopak mata
Kelopak mata bawah > sering drpd atas (1,4:1)Tidak khas !
nodule, plak dg tepi ireguler, luka kronis, fissura kulit, tepi
mengkilat, telengiektasis, ulserasi, papiloma, cutaneous horn, lesi
kistik
sering didaerah limbus, pada fissura interpalpebra sering mirip
pterygium
Menjadi tumor ganas korneabila menginvasi daerah kornea
Pemeriksaan lain :Hertel exophthalmometriPalpasi lymphe node
regionalTes faal heparAnalisa genetis untuk xeroderma
pigmentosumTes HIVCTscan
POLA INVASI DAN METASTASISDermis otot orbicularis
superficialWajah, periosteum, pembuluh lymphe, pembuluh darah,
selubung syarafKlasifikasi BRODERS grade I,II,III,IVGrade 1: 75%
keratinocytes are well differentiatedGrade 2: >50% keratinocytes
are well differentiatedGrade 3: >25% keratinocytes are well
differentiatedGrade 4: 4 cmT4 invasif pada tulang dan otot
TERAPIPEMBEDAHANBedah eksisi dengan :Tehnik MohsVriescopeDiikuti
dengan bedah rekonstruksi
Kadang diperlukan eksenterasi orbita dan eksisi en bloc bila
telah melibatkan tulang
RADIOTERAPIBila ada KI bedah atau menolak operasiSCC lebih
resisten dosis lebih Kelemahan :Tepi tidak terkontrolKomplikasi
post radiasiKunjungan berulang kaliTidak dapat :area yang pernah
diradiasi, tumor di tengah kelopak, usia < 40 th, xeroderma
pigmentosum
CRYOTERAPIKelebihan : biaya, nyaman, potensiasi kataraktogenik ,
dapat diulangTidak dapat : tumor terfiksasi di periosteum, pada
canthus medialis, diameter >10 mm, lesi tidak jelas tepinya,
lesi melebihi conjungtiva fornixNitrogen cair semprot dengan
melindungi bola mataES depigmentasi, bulu mata hilang, hipertrofi
scar, ektropion, epifora, hiperplasia pseudoepitelomatous
KEMOTERAPISebagai terapi tambahan untuk SCC kelopak mata
lanjutCisplatin, atau kombinasi dengan doxorubicin, bleomycin,
isotretinoin, -interferon
FOLLOW UPCuriga SCC kelopak mata evaluasi 6-12 bulanTelah
mengenai lymph node 2-3 bulan selama 2 th pertama
PENCEGAHANSunscreen SPF 15 wajah dan kelopak mata bawah, dan
dioleskan tipis-tipis pada kelopak mata atas dan dahiPakaian dan
topi pelindungMenghindari paparan sinar matahari pk. 10.00-15.00
WIB sore Menurunkan 78%
It isn't the things that happen to us in our lives that cause us
to suffer, it's how we relate to the things that happen to us that
causes us to suffer. - Pema Chodron
BASAL CELL CARCINOMAMost common human malignancyElderly
patientsChronic exposure to sunlightSlow growing, locally invasive,
non metastating
Nodulo-ulcerative BCC shinny, firm, pearly nodule, small
dillated blood vessel on its surface growth slow central
ulceration, raised rolled edges (rodent ulcer)
Sclerosing BCC difficult to dx infiltrates laterally beneath the
epidermis plaque palpation better than inspection to determine the
tumor.
TreatmentSurgical excision remove the entire tumour but preserve
as much normal tissue as possible together with 4 mm margin tissue
which looks clinically normal large tumour frozen section or Moh
micrographic surgeryReconstruction the defectsRadiotheraphy for
nodulo-ulcerative BCC with no involvement of medial canthal area
and unsuitable for/refuse surgery
Cryotheraphy small superficial BCCLaser microsurgery
well-circumscribed BCC of the lid margin without conjunctival
extentionTreatment
A education isnt how much you have committed to memory, or even
how much you know, its being able to differentiate between what you
know and what you dont.
-Anatole France
MELANOMA MALIGNAORIGIN :-arising from PAM (primary acquired
melanosis) with atypia 75 %-arising from a pre existing naevus 20
%-primary melanomais the least common 6th decade
Signs MM conjunctiva :A solitary, black or grey nodule
containing dilated feeder vessels which may become fixed to the
scleraAmelanotic tumours are pink, smooth, fish-flesh app.A common
site is the limbus (may arise everywhere)
Therapy :Circumscribe melanoma wide excision with clearence and
cryotherapy to prevent reccurence incomlete clearence + re excision
and cryotherapy follow up every 6-12 monthly suspicious area biopsy
and impression citologyDiffuse melanoma excision and cryotherapy or
mitomicin C Orbital recurences local resection and
raadiotherapyLymph node involve excision and radiotherapyPalliation
chemotherapy for metastatic disease
Prognosis5 ysr 12 %10 ysr 25 %Metastase : regional lymph nodes,
lung, brain, liver
Signs MM eyelid :Rare, but lethalSuperficial spreading melanoma
plaque with an irregular outline and variable pigmentationNodular
melanoma blue-black nodule surrounded by normal skinMelanoma arisin
gfrom lentigo maligna (slowly expanding pigmented macule in elderly
Hutchinson freckle)
Signs MM ciliary body :In the sixth decade with visual
symptomsDiscovered incidentallyPupillary dilatation and
gonioscopyDilated episcleral blood vessels in the same quadrant of
tumour
Extraocular extension through sclera
Pressure to the lens astigmatism, subluxation
Erosion iris rootRetinal detachment caused by post extension
Anterior uveitisAnnular/ circumferential growth 360- worst
prognosis e.c difficulty to diagnose
DiagnosticTriple mirror contact lensTransillumination for
amelanotic melanomaUSG Biopsy
TherapyEnucleation large tumour and affecting the anterior
choroid, secondary glaucoma Iridocyclectomy small medium tumours
involving less than one third of the angleRadiotherapy
Signs MM choroid :Sixth decade of lifeDecrease VA or VF
defectThird patients very brief balls of light traveling across the
visual field two-three times a day in the subdued lightingElevated
subretina, dome shaped, brown or grey mass, mottled with dark
brown/ black pigment/ amelanotic.Mushroom shape app if breaks
through Brunch membrane
Secondary exudative RDChoroidal folds, haemmorrhage, secondary
glaucoma, cataract, and uveitis
Diagnosis Binocular indirect ophthalmoscopyIndirect slit lamp
biomicroscopyUSGFFAICGMRIFNAB
METASTASIS lung, mammae, GIT
TREATMENTSBrachytherapy tumours < 10 mm in elevation and <
20 mm in basal dia.External radiotherapy more posterior (> 4 mm
of the disc)Transpupillary thermotherapy (w/ diode laser) small
tumours, location near the fovea or optic discTrans scleral local
resection = excision tumours with the rim of healthy choroid under
a partial thickness scleral flap too thick for radiotherapy, <
16 mm in dia.
Stereotatic radiosurgery large tumours with preservation of
visual function in selected caseEnucleation very large tunours,
visual lossExenteration extensive extraocular extension or orbital
recurrencesPalliation chemo therapy / immunotherapy metastatic
disease
PROGNOSISLung metastatic < 1 year, Liver metastatic < 6
mo
All our dreams can come true, if we have the courage to pursue
them. Walt Disney
