Skin and subcutaneous tissue
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SKIN AND SUBCUTANEOUS TISSUE PowerPoint PPT Presentation


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SKIN AND SUBCUTANEOUS TISSUE. I. Introduction A. Function 1. Protection 2. Thermoregulation 3. Sensory. B. Anatomy 1. Epidermis – most cellular layer a. keratinocytes – most numerous and forms a mechanical barrier b.Langerhan’s – immunologic function

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SKIN AND SUBCUTANEOUS TISSUE

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Skin and subcutaneous tissue

SKIN AND SUBCUTANEOUS TISSUE


Skin and subcutaneous tissue

I. Introduction

A. Function

1. Protection

2. Thermoregulation

3. Sensory


Skin and subcutaneous tissue

B. Anatomy

1. Epidermis – most cellular layer

a. keratinocytes – most numerous

and forms a mechanical barrier

b.Langerhan’s – immunologic function

c. Melanocytes – pigment


Skin and subcutaneous tissue

2. Dermis – supporting layer, mostly fibroblast which produce collagen

3. Basement layer – dermal epidermal junction

- first layer where blood vessel and lymphatics are present

- if lesion has not crossed this layer, it is called an “in-situ” lesion


Skin and subcutaneous tissue

II. Pathology

A. Trauma

1. Dirty and infected wounds – debridement and closed by secondary intention

2. Lacerations – closed primarily


Lacerations

LACERATIONS


Skin and subcutaneous tissue

B. Decubitus Ulcer or Pressure Ulcer

- excessive, unrelieved pressure (60 cm Hg applied for 1 hour)

- muscle more sensitive than skin to ischemia

- Tx. – debridement and grafting


Decubitus ulcer

DECUBITUS ULCER


Skin and subcutaneous tissue

C. Keloid and Hypetrophic Scar

- over abundance of deposition of collagen

1. Hypertrophic scar – nodularity remains within the incision

- no treatment necessary

2. Keloid – nodularity goes beyond the incision

- seen more in children and across sternum

- treated with triamcinolone


Keloid

KELOID


Skin and subcutaneous tissue

D. Infections

1. Folliculitis – infected hair follicle

- caused by Staph. sp.

- leads to furuncle  carbuncle

- Tx. – incision and drainage and antibiotics

2. Hidradenitis suppuritiva

- plugged apocrine gland in axilla and inguinal area

- Tx. – warm compress, hygiene, discontinuation of deodorants, open drainage if recurrent


Skin and subcutaneous tissue

3. Pilonidal disease – infected pilosebaceous cysts in the saccrococygeal area, lined by granulation tissue

- Tx. – drainage, currete


Skin and subcutaneous tissue

4. Staphyloccocal Scalded Skin Syndrome

- erythema, bullae formation, loss of epidermis

- caused by exotoxin from staphyloccocal infection

- similar to partial thickness burn

-cleavage is in the granular layer

- Tx. – replace fluid, electrolytes, skin care,

antibiotics


Staphylococcal scalded skin syndrome

STAPHYLOCOCCAL SCALDED SKIN SYNDROME


Skin and subcutaneous tissue

5. Toxic Epidermal Necrolysis

- Immunologic reaction to certain drugs such as sulfonamides, phenytoin, barbituates, and tetracycline

- Tx. – same as SSSS

6. Viral – verruca vulgaris, associated with pappiloma virus

- associated with squamous cell ca

- Tx. – chemical, electrocautery, surgery


Skin and subcutaneous tissue

E. Benign Tumors

Cysts

1. epidermal – sebaceous cysts, most common

2. Trichilemmal – occurs more commonly in females

3. Dermoid – results from epithelium trapped during midline closure in fetal development

- Tx. - excision


Skin and subcutaneous tissue

F. Nevi

1. Acquired

a. Junctional – epidermis

b. Compound – migrates partially

down to the dermis

c. Dermal – cells at dermal layer

- involutes


Acquired nevi

ACQUIRED NEVI


Skin and subcutaneous tissue

2. Congenital – rare

- large and may contain hair

- occurs in bathing trunks distribution

- Tx. - excision


Congenital nevi

CONGENITAL NEVI


Skin and subcutaneous tissue

G. Vascular

1. Hemangioma

a. capillary (strawberry)

- compressible, vascular lesion with sharp borders

- located mostly in the face, scalp, and shoulder - observe, 90% involute


Skin and subcutaneous tissue

b. Cavernous

- bright red or purple, with spongy consistency

- Tx. – excision

2. Vascular malformation

- enlarged vascular spaces lined with non proliferating endothelial cells

a. portwine stain – capillary malformation

- Tx. – embolization

b. glomus tumor – painful blue –gray nodules

- arises from the glomus body or Sucquet-Hoyer canal found in the dermis and contributes to thermal regulation

- may lead to glomangiosarcoma

- Tx. - excision


Glomus tumor

GLOMUS TUMOR


Skin and subcutaneous tissue

H. Soft Tissue Tumors ( achrocordons, lipomas, dermatofibromas)

- Tx. – excision

I. Neural

- Neurofibromas (café-au-lait spots)

- associated with von Reklinghausen’s disease


Skin and subcutaneous tissue

J. Malignant Tumors

1. Epidemiology

a. malignant radiation

b. chemicals

c. viral

d. chronic irritation

e. immunosuppresion


Skin and subcutaneous tissue

2. Types

a. basal cell carcinoma

- most common

- slow growing, rare metastases

- excision with 2-4 mm margin


Basal cell carcinom

BASAL CELL CARCINOM


Skin and subcutaneous tissue

b. squamous cell carcinoma

- metastasizes faster

- Bowen’s disease – ca-in-situ

- Erythroplasia of Queyrat – ca of the penis

- lesion more than 1 cm has 50% chance of metastasis

- Tx. – excision with 1 cm margin

- Moh’s technique – serial excision to preserve skin


Squamous cell carcinoma

SQUAMOUS CELL CARCINOMA


Erythroplasi of queyrat

ERYTHROPLASI OF QUEYRAT


Skin and subcutaneous tissue

c. malignant melanoma

- arises from dysplastic melanocytes

i. superficial spreading

- most common (70%)

- flat with areas of regression


Skin and subcutaneous tissue

ii. nodular – 15-20%

- dark, slightly raised

- growth more vertical than radial

iii. lentigo malignant 5-10%

- best prognosis

- occurs in areas of high solar degeneration


Melanoma

MELANOMA


Skin and subcutaneous tissue

b. prognostication

i. Clark

ii. Breslow

iii other factors

- anatomic location – extremities better than trunk or face

- ulceration


Skin and subcutaneous tissue

- inflammatory infitrates

- sex

- histologic type

c. treatment

- still primarily surgical

i. in-situ - .5 to 1 cm margin

ii. T1 (smaller than .76 mm)

- 1-2 cm

iii. thicker lesion – 3 cm margin

- excision is up to the deep fascia

- chemotherapy

- palpable nodes are removed by regional dissection


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