MANAGEMENT OF BASAL CELL CARCINOMA

AT FOREHEAD WITH EXCISION AND CLOSURE

DEFECT FLAP-H
 CONT

Tumor are common in white skin and

relatively rere in drak skin
More men than women
Especially 40 years old. 1
 BACKGROUND
Basal cell carcinoma is a malignant skin tumor
originating from the growth of pluripotensial
cell or differentiate cells in the basal stratum
and apendiks skin. 1,2,3,4
Synonim basal cell carsinoma: basal cell
epitelioma, basalioma, rodent carsinoma,
komprecher tumor. 1,2,3
This tumor growth is slow to give clinical
features that vary, and rarely metastasize. 1,2,3,4
 Etiologi
The exact cause of KSB is unknown,
presumably often exposed to the sun. In
addition there are other factore, such as X-ray
radiation of arsenic chemical compounds,
recurrent trauma and chronic ulcers. 1
 PATHOGENESIS 1

Pluri Potential cells in the Dimer cylobutame-type piramidin

stratum basalis develop (cpd), pyramidine (6-4), derivat (6-4)
continously photoproduct

Generally derived from the Ultraviolet radiation destroys

epidermis and can also from the hair
DNA and produces
follicle root shell

Carsinogens are a gradual and Ultraviolet radiation has a

complex process of accumulation of relationship in the pathogenesis of
genetic changes skin cancer
 Epidemiologi
Increased in those who work or move outside
the home that is often exposed to sunlight
Examples :
Such as sailore
Farmers
And people who like to exercise outdoors. 1,2
 Predilektion
More on the face ( cheeks, forehead, nose,
nasolabial folds, periorbital ) and neck.
It is rare in the arms, hands, body, legs, feet
and scalp. 4
 Description
Very varied divided into 5 forms :
1) Nodulo ulserative
2) Pigment
3) Morfea / fibrosing / sklerosing
4) Superfisial
5) Fibroepithelioma. 4
 DIFFERENTIAL DIAGNOSIS
Differential Diagnosis Basal Cell Carsinoma
include:
1. Melanotik
2. Nevus
3. Seborrhoeic keratosis
4. Squamosa cell carcinoma. 4
 pathologi
Pathological features are also different but
they all show proliferation of relatively large
basofilik nuclei cells and a non-full cytoplasm.6
 Management

Curettage
Electrodesiccation
Excisional surgery
Radiotherapy
Cryosurgery
Mohs micrographic surgery
New treatment combined fluorouracil 5 with
curettage. 6
 prognosis
BCC is very easy to recurrence, so the right
action really determinens the prognosis.
The purpose of surgical excision at BCC by
removing the entire mass of the tumor with a
minimum of slices or good result
 CONT
Excision surgery is a surgery that uses
reconstruction to form a Flap.
The H-flap technique is a simple flap
technique that is easy to do with satisfaisctory
results. H flap is often used to cover simple
linear defects and form a bilateral rectangular
pedicle. This flap technique varies greatly
based on local flap movement divided over
linear and protational (pivotal)
 CONT
Flap advencement is a kind of linear flap by
moving the adjacent skin perpendiculary to
close the defec, by direct shifting over the
defect. Its function of moving the excision line
becomes more hidden so more cosmetic.
 CASE
A men 40 year old, came to the cosmetic and
dermatology clinic of Permata Bunda Medan
Hospital with complaints of wound forehead 3
years ago. Initially the lesion just a small
nodule like a mole. That becomes a awound
never healed and increased, and grew wider
bleeding.
 Examination
Physical examination:
KU : good
TD :120/80 mmhg
HR :80 x/i
RR :20 x/i
T :36,80 C
Dermatology examination:
the found ulcer of size 2,5 cm x 1,5 cm which has been
bleeding, skuama smooth and crusta thin on the frontalis
region.
 Differential diagnosis
1. Basal cell carcinoma
2. Seborrheic keratoses
3. Nevus pigmentosa
 Examination
Routin : DBN
Performed excision and closure the H-flap
defects.
Operation report :
o The Patient is laid on operating table of
supination position
o Filed operation position disinfection with
povidon iodine 10% then alcohol 70%
 Examination laboratory
Creat auxiliary lines, with gentian violet 1 cm.
the lesion outside as an excision guide the
aquare the skin slices of approximately 3 cm
horizontal direction.
Then give the local anasthesia with (mixture of
Nacl 0,9 100ml lidocaine 2% ml adrenaline 1 :
1000 0,1 ml) infiltrated on the operating area
and wait for 20 minutes.
 Treatment
Completed rectangular excision incision to the
subcutaneous border using knife number 15.
square skin tissue removed with tweezers
removed from the underlying tissue using
scissors.
Then undermaining using clamps on subcutis 1
cm from the incision edge. The extended incision
that touches the letter H serves to facilitate the
union of incisions and stitches on the wound.
 Treatment
Bleeding is stopped using pressure with steril
gauze
Wound sewn dlawall subcuticular sutures using
silk 3-0 so that proceeded epiderma stitch using
nylon 5-0 so that touch H-flap
Which has been sewn smeared antibiotic
ointment and then closed using sterilegauze and
plaster.
patients of General condition good post-
operationt
 CONT
Patients are given treatment systemic
cefadroxyl antibiotics 2x500 mg/day,
mefenamic acid 3x500mg/day, and natrium
fusidate ointment post-operation.
Excised tissue is sent to pathology for
histopatological examination.
 Cont
On the 3rd day of the day, the treatment was
given cefadroxyl 2x500 mg/day, mefenamic acid
3x500mg/day (if still pain) , and natrium fusidate
ointment
At the 7th day of control dry wound was
performed the opening of therapy suture in the
form of natrium fusidate ointment.
After 2 months later the wound looks better and
after 12 months the patien comes back the skin
on the wound look getting better, signs of
recurrens are not visible. The wound shows
satisfactory result.
Prognosis in this case is good.
 histopatological examination result
There appears an irregular mass preparation
of basaloid cells formed in the dermis with the
uppermost cells,
Forming a palisade layer at the edges,
The surrounding stroma exhibiting a fibrous
reaction
 DISCUSSION
Diagnosis in the case are anamnesis, examination physical,
and hystopathologi.
Anamnesis: obtained a papuls like nevus and ulcerative
easily bleed, smooth squama, thin krusta without pruritus
Examination physical:
The dermatologi : ulcerative, krusta and ulcerative easily
bleed without pruritus, painful and diameter 2,5 cm x 1,5
cm regio frontalis. Predilection are the face, especially
the cheek, fold, nasolabia, forehead, and eyelid.
Hystopathologi
Iregular mass of basoloid cells
Located in the dermis with cells foring a layer of palisade
on the edges
stroma
Fibrous reaction
 Etiologi
The exact cause is unkknown. Allegedly due to
exposure to long sublight, especially by
ultraviolet light
 Differential diagnosis
Nevus pigmentosus :
In the junctional naevus : nevus cells in the stratum
basal epidermis as poligonal cell, nucleus, pigment, and
nevus cell are visible at the ends of the tiered rate
ridge
Nevus compound : nevus cells in the stratum basal
epidermis zona links dermo epidermis and dermis
Keratosis seboroik
Looks : hyperkeratosis, acanthosis, and papilomatosis
The boundary of the tumor lies in line with the normal
epidermis
 Management
In the patien Extensive excision in performed
with H-flap closur
Operating technique 7
Fusiform Incision
Simple flap
Full thickness skin tone
Split thickness
 Handing surgery excision ofa large malignant
skin tumor of the incision outside the tumor
boundary is usually 0,5-1 cm
Performed closure of the defect accompanied
by the closure of the skin layer
The follow-up action is followed up 2,6 and 12
months of youth
Evwry 6-12 months for 5 years
 Conclusion
Continuous exposure to sunlight can induce
the growth of skin cance
The use of a topical sunscreen is one way that
can reduce the risk of the growth of skin cacer
The use of sunscreen in different activities
with SPF 6-8 whereas outdoor activities such
as exercising or recreation are required SPF
above 15-30.
 Conclusion
Dignosis :
Basal cell carsinoma ulcerative nodules
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