1 / 27

SKIN

april
Download Presentation

SKIN

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

    1. SKIN Western Reserve Care System Northside Medical Center Department of Surgery

    2. Anatomy Layers of the Skin: Epidermis Keratinocytes Melanocytes Dermis Skin Appendages Hair Follicles Sweat Glands Eccrine or merocrine sweat glands Apocrine sweat glands Sebaceous glands

    3. Sensory Nerves Pacinian Corpuscles – pressure Ruffini’s Endings – warmth Krause’s end bulbs – cold Meissner’s Corpuscles – tactile sense

    4. Sweat Glands Exocrine Glands – aqueous sweat (thermal regulation, hypotonic usually) Apocrine Glands – milky sweat, highest concentration in palms and soles

    5. Langerhans Cells Act as antigen presenting cells Originate from bone marrow Act in role as hypersensitivity reaction (Type IV)

    6. Misc. Facts Lipid soluble Drugs have increased skin absorption Type I collagen- gives tensile strength and makes up 70% of dermis Tension is provided by collagen in skin Elasticity ability of regain shape Cushings’s Striae – loss of both tensile strenght and elasticity.

    7. Pressure Ulcers

    8. Example Stage IV Ulcer

    9. Melanoma Risk Factors: 1) dysplastic, atypical or lg congenital nevi 2) Familial BK mole syndrome 3) Xeroderma Pigmentosum Most common site of melanoma – back in men, legs in women

    10. Melanoma Manifestations

    11. Melanoma Continued Worse prognosis for men, ulcerated lesions, occular or mucosal lesions Originates form neural crest cells in basal layer of the epidermis Lung is most common location of distant metastases Small bowel is most common overall location of metastases

    14. Basal Cell Carcinoma MC malignancy in US, 4x MC than squamous Pearly appearance, rolled borders Peripheral palisading of nuclei and stromal retraction Ulcerative, no metastases, deep invasion Morpheaform type is most aggressive, has collagenase production, Tx w/.3-.5cm margins

    15. Basal Cell Carcinoma

    17. Squamous Cell Carcinoma Risk Factors – actinic keratoses, zeroderma pigmentosum, bowen’s disease, atrophic epidermitis, arsenic, coal tar, nitrates, HPV, fair skin, XRT exposure Tx: .5-1.0cm margins for low risk Reginal adenectomy for positive nodes Mohs Surgery – margin mapping using conservative slicles, never used for melanoma, best for facial lesions

    18. Squamous Cell Carcinoma

    19. Kaposi’s Sarcoma Vascular sarcoma Can involves, skin, mucus membranes of GI tract Associated with AIDS/HIV Tx XRT of intralesional vinblastine for lcoal disease, Sx for intestinal hemorrage

    20. Xanthomas Yellow lesions, associated with fatty deposition. Contain histocytes. Tx excision.

    21. Verruca Vulgaris HPV viral origin Tx liquid nitrogen Gardacil Vaccine protects against several varities of skin as well as cervical HPV

    22. Neuromas Associated with NF1 & NF2. Look for café au lait spots or axillary freckling for dx.

    23. Keratoses Actinic Keratosis – premalignant, sun damamged ares, Bx if suspicious Seborrheic Keratosis – no premalignant, trunk of elderly Arsenical keratosis – assoicated with squamous cell carcinoma

    24. Benign Cysts Epidermal Inclusion Cysts MC, mature epidermis with creamy keratin material Trichilemmal Cyst In scalp, no epidermis Ganglion Cyst Over tendons, usually on wrist, filled with collagenous material

    25. Benign Cysts Continued Pilonidal Cyst Congenital coccygeal sinus with ingrown hair, excise the wall

    26. Keloids Autosomal Dominant Collagen goes beyond original scar Tx: XRT, steroids, silicone, pressure garments

    27. Hypertrophic Scar Tissue Predisposition – dark skin, flexor surfaces of upper torso Collagen stays within confines of scar Often occurs in burn tissue Tx: steroids, silicone, pressure garments

More Related