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Wide eksisi dan flap rhomboid pada karsinoma basal sel regio facial



Abstract

Background: Basal cell carcinoma is one of the most common classifications of non-melanoma skin cancer (75% - 80%) of all cancers. Basal cell carcinoma causes widespread local destruction including soft tissue, cartilage, and bone, thus impairing function and aesthetics, especially for the facial area. One of the most common reconstructive techniques for Basal Cell Carcinoma is the Rhomboid flap. This case report aims to report the use of the rhomboid flap reconstruction technique in post-wide excision of basal cell carcinoma.

Case Description: A man, 54 years old, ethnic Balinese, came to the General Surgery Clinic of RSUD Klungkung with a complaint that a mole on the patient's left eye appeared enlarged with itching and bleeds easily. These complaints began to be felt since about 2 weeks before entering the hospital. Initially the patient's mole had been there for 5 years, previously the patient had no complaints about the mole, the initial lesion was in the form of a small brownish lump which was then felt to be getting bigger with itching and bleeding easily. The patient did not complain of pain. Examination of the localized status on the lateral periorbital sinistra showed blackish nodules with hyperpigmented macules, solitary, 2cm x 1cm in size, visible erosions, well-defined borders, irregular shape.

Conclusion: The provisional diagnosis of Suspected Malignant Skin Tumor was established based on history, physical examination, with management therapy wide excision and reconstruction with Rhomboid Flap followed with biopsy.

 

Latar Belakang : Karsinoma Sel Basal (KSB) adalah salah satu kanker kulit  yang paling sering ditemukan dari seluruh kanker kulit non melanoma.  Karsinoma Sel Basal dapat mengakibatkan kerusakan local dengan infiltrasi yang luas sehingga mengganggu fungsi dan estetika, terutama untuk daerah wajah. Salah satu pilihan  teknik rekonstruksi yang bisa dilakukan pada Karsinoma Sel Basal di regio wajah  adalah Rhomboid flap. Laporan kasus ini bertujuan untuk melaporkan penggunaan tehnik rekonstruksi dengan flap rhomboid pada pasca eksisi luas pada karsinoma sel basal.

Deskripsi Kasus: Seorang laki-laki, 54 tahun, suku Bali,  datang ke Poliklinik bedah Umum RSUD Klungkung dengan keluhan tahi lalat pada sebelah mata kiri pasien tampak membesar disertai gatal dan mudah berdarah. Keluhan tersebut mulai dirasakan sejak sekitar 2 minggu sebelum masuk RS. Awalnya tahi lalat pasien sudah ada sejak 5 tahun yang lalu, sebelumnya pasien tidak ada keluhan pada tahi lalat tesebut, lesi awal berupa benjolan kecil berwarna kecoklatan yang kemudian makin lama dirasakan makin membesar disertai rasa gatal dan mudah berdarah. Keluhan nyeri tidak dikeluhkan oleh pasien.  Pemeriksaan status lokalis pada periorbital lateral S tampak nodul kehitaman disertai makula hiperpigmentasi, soliter, ukuran 2cm x 1cm, tampak erosi, batas tegas, bentuk tidak beraturan.

Kesimpulan: Diagnosis sementara Tumor Kulit Suspek Malignant ditegakkan berdasarkan anamnesis, pemeriksaan fisik dengan terapi eksisi luas + biopsi + rekonstruksi dengan Rhomboid Flap.

Keywords: Karsinoma Sel Basal Tumor Kulit Malignant Eksisi Rhomboid Flap

References

  1. Reinau D, Surber C, Jick SS, Meier CR. Epidemiology of basal cell carcinoma in the United Kingdom: Incidence, lifestyle factors, and comorbidities. Br J Cancer. 2014;111(1).
  2. Basset-Seguin N, Herms F. Update on the management of basal cell carcinoma. Vol. 100, Acta Dermato-Venereologica. 2020.
  3. Dika E, Scarfì F, Ferracin M, Broseghini E, Marcelli E, Bortolani B, et al. Basal cell carcinoma: A comprehensive review. Vol. 21, International Journal of Molecular Sciences. 2020.
  4. Pellegrini C, Maturo MG, Di Nardo L, Ciciarelli V, Gutiérrez García-Rodrigo C, Fargnoli MC. Understanding the molecular genetics of basal cell carcinoma. Vol. 18, International Journal of Molecular Sciences. 2017.
  5. Feller L, Khammissa RAG, Kramer B, Altini M, Lemmer J. Basal cell carcinoma, squamous cell carcinoma and melanoma of the head and face. Vol. 12, Head and Face Medicine. 2016.
  6. Wilvestra S, Lestari S, Asri E. Studi Retrospektif Kanker Kulit di Poliklinik Ilmu Kesehatan Kulit dan Kelamin RS Dr. M. Djamil Padang Periode Tahun 2015-2017. J Kesehat Andalas. 2018;7.
  7. Walker HS, Hardwicke J. Non-melanoma skin cancer. Vol. 40, Surgery (United Kingdom). 2022.
  8. DEWI M. Sebaran Kanker di Indonesia, Riset Kesehatan Dasar 2007. Indones J Cancer. 2017;11(1).
  9. Yogiswara IGAI, Saputra H, Ekawati NP. Karakteristik pasien kanker kulit non-melanoma di RSUP Sanglah pada periode tahun 2014 - 2018. Intisari Sains Medis. 2021;12(2).
  10. Coit DG, Thompson JA, Albertini MR, Barker C, Carson WE, Contreras C, et al. Cutaneous Melanoma, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Cancer Netw. 2019;17(4).
  11. Savoia P, Cremona O, Fava P. New Perspectives in the Pharmacological Treatment of Non-Melanoma Skin Cancer. Curr Drug Targets. 2015;17(3).
  12. Alhumidi A. Simple approach to histological diagnosis of common skin adnexal tumors. Pathol Lab Med Int. 2017;Volume 9.
  13. Cullen JK, Simmons JL, Parsons PG, Boyle GM. Topical treatments for skin cancer. Vol. 153, Advanced Drug Delivery Reviews. 2020.
  14. Fialová A. Non-melanoma skin cancers. Onkol (Czech Republic). 2020;14(5).
  15. Bichakjian C, Armstrong A, Baum C, Bordeaux JS, Brown M, Busam KJ, et al. Guidelines of care for the management of basal cell carcinoma. J Am Acad Dermatol. 2018;78(3).
  16. Olds CE, Pepper JP. Health Outcome Studies in Skin Cancer Surgery. Vol. 27, Facial Plastic Surgery Clinics of North America. 2019.
  17. Lai V, Cranwell W, Sinclair R. Epidemiology of skin cancer in the mature patient. Clin Dermatol. 2018;36(2).
  18. Xavier-Junior JCC, Ocanha‐Xavier JP. WHO (2018) Classification of Skin Tumors. Am J Dermatopathol. 2019;41(9).
  19. Lever’s Histopathology of the Skin, 10th edition. J Cutan Pathol. 2009;36(5).
  20. Krum Dos Santos AC, Lima D, Marchiori Bakos R, da Silva Cartell A, Rangel Bonamigo R. Stromal α-Smooth Muscle Actin Positivity Is Associated With High-Risk Basal Cell Carcinomas. Am J Dermatopathol. 2021;43(12).
  21. Álvarez-Salafranca M, Ara M, Zaballos P. Dermoscopy in Basal Cell Carcinoma: An Updated Review. Actas Dermosifiliogr. 2021;112(4).
  22. Pecora A, Laprise J, Dahmene M, Laurin M. Skin cancers and the contribution of rho GTPase signaling networks to their progression. Vol. 13, Cancers. 2021.
  23. Abbas OL, Borman H. Basal Cell Carcinoma: A Single-Center Experience. ISRN Dermatol. 2012;2012.
  24. Cameron MC, Lee E, Hibler BP, Barker CA, Mori S, Cordova M, et al. Basal cell carcinoma: Epidemiology; pathophysiology; clinical and histological subtypes; and disease associations. Vol. 80, Journal of the American Academy of Dermatology. 2019.
  25. Salgarelli AC, Bellini P, Multinu A, Magnoni C, Francomano M, Fantini F, et al. Reconstruction of Nasal Skin Cancer Defects with Local Flaps. J Skin Cancer. 2011;2011.
  26. Li JH, Xing X, Liu HY, Li P, Xu J. Subcutaneous island pedicle flap: Variations and versatility for facial reconstruction. Ann Plast Surg. 2006;57(3).
  27. Kwon KH, Lee DG, Koo SH, Jo MS, Shin H, Seul JH. Usefulness of V-Y advancement flap for defects after skin tumor excision. Arch Plast Surg. 2012;39(6).
  28. Heller L, Cole P, Kaufman Y. Cheek Reconstruction: Current Concepts in Managing Facial Soft Tissue Loss. Semin Plast Surg. 2008;22(04).
  29. Jovic TH, Jessop ZM, Slade R, Dobbs T, Whitaker IS. The Use of Keystone Flaps in Periarticular Wound Closure: A Case Series. Front Surg. 2017;4.
  30. Rao JK, Shende KS. Overview of local flaps of the face for reconstruction of cutaneous malignancies: Single institutional experience of seventy cases. J Cutan Aesthet Surg. 2016;9(4).
  31. Thornton J. Local Flaps in Facial Reconstruction, Second Edition. Plast Reconstr Surg. 2010;126(1).
  32. Sakamoto Y, Nakajima H, Kishi K. The rhombic bilobed flap, a simple, geometrically designed flap. J Cutan Aesthet Surg. 2014;7(3).
  33. Kang AS, Kang KS. Rhomboid flap: Indications, applications, techniques and results. A comprehensive review. Vol. 68, Annals of Medicine and Surgery. 2021.
  34. Shrestha BB, Karmacharya M, Bogati L, Ghimire P. Prevalence of complications after limberg rhomboid flap in patients with cutaneous defects at tertiary care hospital. J Nepal Med Assoc. 2019;57(216).
  35. Sanjaya IGPH, Hamid ARRH, Samsarga GW. One stage release of circumferential constriction band in upper limb with multiple Z-plasty technique: a case report. Indones J Biomed Sci. 2019;13(2).
  36. Fahradyan A, Howell AC, Wolfswinkel EM, Tsuha M, Sheth P, Wong AK. Updates on the management of non-melanoma skin cancer (Nmsc). Vol. 5, Healthcare (Switzerland). 2017.

How to Cite

Nopy Arianti, K., Made Oka Sastrawan, Fatur Reyhan Muradi, Muhammad Aflah, & Casvin Jus. (2022). Wide eksisi dan flap rhomboid pada karsinoma basal sel regio facial. Intisari Sains Medis, 13(3), 640–644. https://doi.org/10.15562/ism.v13i3.1505
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Kadek Nopy Arianti
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Made Oka Sastrawan
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Fatur Reyhan Muradi
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Muhammad Aflah
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Casvin Jus
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