skin and subcutaneous tissue. i. introduction a. function 1. protection 2. thermoregulation 3....
TRANSCRIPT
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SKIN AND SKIN AND SUBCUTANEOUS TISSUESUBCUTANEOUS TISSUE
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I. IntroductionI. Introduction
A. FunctionA. Function
1. Protection1. Protection
2. Thermoregulation2. Thermoregulation
3. Sensory3. Sensory
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B. AnatomyB. Anatomy1. Epidermis – most cellular layer1. Epidermis – most cellular layer
a. keratinocytes – most numerousa. keratinocytes – most numerousand forms a mechanical barrierand forms a mechanical barrier
b.Langerhan’s – immunologic b.Langerhan’s – immunologic functionfunction
c. Melanocytes – pigmentc. Melanocytes – pigment
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2. Dermis – supporting layer, mostly 2. Dermis – supporting layer, mostly fibroblast which produce collagenfibroblast which produce collagen
3. Basement layer – dermal 3. Basement layer – dermal epidermal epidermal junctionjunction
- first layer where blood vessel and - first layer where blood vessel and lymphatics are presentlymphatics are present
- if lesion has not crossed this layer, it - if lesion has not crossed this layer, it is is called an “in-situ” lesioncalled an “in-situ” lesion
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II. PathologyII. Pathology
A. TraumaA. Trauma
1. Dirty and infected wounds – 1. Dirty and infected wounds – debridement and closed by debridement and closed by secondary secondary intentionintention
2. Lacerations – closed primarily2. Lacerations – closed primarily
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LACERATIONSLACERATIONS
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B. Decubitus Ulcer or Pressure UlcerB. Decubitus Ulcer or Pressure Ulcer
- excessive, unrelieved pressure (60 - excessive, unrelieved pressure (60 cm Hg applied for 1 hour)cm Hg applied for 1 hour)
- muscle more sensitive than skin to - muscle more sensitive than skin to ischemiaischemia
- Tx. – debridement and grafting- Tx. – debridement and grafting
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DECUBITUS ULCERDECUBITUS ULCER
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C. Keloid and Hypetrophic Scar C. Keloid and Hypetrophic Scar - over abundance of deposition of collagen- over abundance of deposition of collagen
1. Hypertrophic scar – nodularity 1. Hypertrophic scar – nodularity remains remains within the within the incisionincision
- no treatment necessary- no treatment necessary
2. Keloid – nodularity goes beyond the 2. Keloid – nodularity goes beyond the incisionincision- seen more in children and across sternum- seen more in children and across sternum- treated with triamcinolone- treated with triamcinolone
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KELOIDKELOID
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D. InfectionsD. Infections1. Folliculitis – infected 1. Folliculitis – infected hair hair folliclefollicle- caused by Staph. sp.- caused by Staph. sp.- leads to furuncle - leads to furuncle carbunclecarbuncle- Tx. – incision and - Tx. – incision and drainage drainage and and antibioticsantibiotics
2. Hidradenitis suppuritiva2. Hidradenitis suppuritiva- plugged apocrine gland - plugged apocrine gland in in axilla and inguinal axilla and inguinal areaarea- Tx. – warm compress, - Tx. – warm compress, hygiene, discontinuation hygiene, discontinuation of of deodorants, open deodorants, open drainage if drainage if recurrentrecurrent
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3. Pilonidal disease – infected 3. Pilonidal disease – infected pilosebaceous cysts in the pilosebaceous cysts in the saccrococygeal area, lined by saccrococygeal area, lined by granulation tissuegranulation tissue
- Tx. – drainage, currete- Tx. – drainage, currete
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4. Staphyloccocal Scalded Skin Syndrome4. Staphyloccocal Scalded Skin Syndrome- erythema, bullae formation, loss of - erythema, bullae formation, loss of
epidermisepidermis- caused by exotoxin from staphyloccocal - caused by exotoxin from staphyloccocal infectioninfection- similar to partial thickness burn- similar to partial thickness burn-cleavage is in the granular layer-cleavage is in the granular layer- Tx. – replace fluid, electrolytes, skin - Tx. – replace fluid, electrolytes, skin
care,care,antibioticsantibiotics
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STAPHYLOCOCCAL SCALDED STAPHYLOCOCCAL SCALDED SKIN SYNDROMESKIN SYNDROME
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5. Toxic Epidermal Necrolysis5. Toxic Epidermal Necrolysis- Immunologic reaction to - Immunologic reaction to
certain drugs certain drugs such such as as sulfonamides, phenytoin, sulfonamides, phenytoin, barbituates, barbituates, and tetracyclineand tetracycline
- Tx. – same as SSSS- Tx. – same as SSSS
6. Viral – verruca vulgaris, 6. Viral – verruca vulgaris, associated with pappiloma associated with pappiloma virusvirus- associated with squamous - associated with squamous
cell cell caca- Tx. – chemical, - Tx. – chemical,
electrocautery, electrocautery, surgerysurgery
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E. Benign TumorsE. Benign TumorsCystsCysts1. epidermal – 1. epidermal – sebaceous sebaceous cysts, cysts, most commonmost common
2. Trichilemmal – 2. Trichilemmal – occurs occurs more more commonly in commonly in femalesfemales
3. Dermoid – 3. Dermoid – results results from from epithelium epithelium trapped during trapped during midline closure in midline closure in
fetal fetal developmentdevelopment
- Tx. - excision- Tx. - excision
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F. NeviF. Nevi
1. Acquired1. Acquired
a. Junctional – epidermisa. Junctional – epidermis
b. Compound – migrates partiallyb. Compound – migrates partially
down to the dermisdown to the dermis
c. Dermal – cells at dermal layerc. Dermal – cells at dermal layer
- involutes- involutes
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ACQUIRED NEVIACQUIRED NEVI
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2. Congenital – rare2. Congenital – rare
- large and may contain hair- large and may contain hair
- occurs in bathing trunks - occurs in bathing trunks distributiondistribution
- Tx. - excision- Tx. - excision
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CONGENITAL NEVICONGENITAL NEVI
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G. VascularG. Vascular1. Hemangioma1. Hemangioma
a. capillary a. capillary (strawberry) (strawberry) - compressible, - compressible,
vascular vascular lesion with lesion with sharp borderssharp borders
- located mostly in - located mostly in the the face, scalp, and face, scalp, and shoulder shoulder - observe, 90% - observe, 90% involuteinvolute
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b. Cavernousb. Cavernous- bright red or purple, with spongy - bright red or purple, with spongy
consistencyconsistency- Tx. – excision- Tx. – excision
2. Vascular malformation2. Vascular malformation- enlarged vascular spaces lined with non - enlarged vascular spaces lined with non
proliferating endothelial cellsproliferating endothelial cellsa. portwine stain – capillary malformationa. portwine stain – capillary malformation- Tx. – embolization- Tx. – embolization
b. glomus tumor – painful blue –gray nodulesb. glomus tumor – painful blue –gray nodules- arises from the glomus body or Sucquet-- arises from the glomus body or Sucquet-Hoyer canal found in the dermis and Hoyer canal found in the dermis and contributes to thermal regulationcontributes to thermal regulation- may lead to glomangiosarcoma- may lead to glomangiosarcoma- Tx. - excision- Tx. - excision
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GLOMUS TUMORGLOMUS TUMOR
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H. Soft Tissue Tumors H. Soft Tissue Tumors ( achrocordons, lipomas, ( achrocordons, lipomas, dermatofibromas)dermatofibromas)- Tx. – excision- Tx. – excision
I. NeuralI. Neural- Neurofibromas (café-- Neurofibromas (café-au-lait spots)au-lait spots)- associated with von - associated with von Reklinghausen’s diseaseReklinghausen’s disease
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J. Malignant TumorsJ. Malignant Tumors
1. Epidemiology1. Epidemiology
a. malignant radiationa. malignant radiation
b. chemicalsb. chemicals
c. viral c. viral
d. chronic irritationd. chronic irritation
e. immunosuppresione. immunosuppresion
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2. Types2. Types
a. basal cell carcinomaa. basal cell carcinoma
- most common- most common
- slow growing, rare - slow growing, rare metastasesmetastases
- excision with 2-4 mm margin- excision with 2-4 mm margin
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BASAL CELL CARCINOMBASAL CELL CARCINOM
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b. squamous cell carcinomab. squamous cell carcinoma- metastasizes faster- metastasizes faster- Bowen’s disease – ca-in-situ- Bowen’s disease – ca-in-situ- Erythroplasia of Queyrat – ca of - Erythroplasia of Queyrat – ca of
the penisthe penis- lesion more than 1 cm has - lesion more than 1 cm has
50% 50% chance of metastasischance of metastasis- Tx. – excision with 1 cm margin- Tx. – excision with 1 cm margin- Moh’s technique – serial - Moh’s technique – serial
excision to excision to preserve skinpreserve skin
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SQUAMOUS CELL SQUAMOUS CELL CARCINOMACARCINOMA
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ERYTHROPLASI OF QUEYRATERYTHROPLASI OF QUEYRAT
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c. malignant melanomac. malignant melanoma
- arises from dysplastic - arises from dysplastic melanocytesmelanocytes
i. superficial spreadingi. superficial spreading
- most common (70%)- most common (70%)
- flat with areas of regression- flat with areas of regression
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ii. nodular – 15-20%ii. nodular – 15-20%- dark, slightly raised- dark, slightly raised- growth more vertical than - growth more vertical than
radialradial
iii. lentigo malignant 5-10%iii. lentigo malignant 5-10%- best prognosis- best prognosis- occurs in areas of high - occurs in areas of high
solar solar degenerationdegeneration
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MELANOMAMELANOMA
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b. prognosticationb. prognosticationi. Clarki. Clarkii. Breslowii. Breslowiii other factorsiii other factors- anatomic location – - anatomic location – extremities better than extremities better than
trunk trunk or faceor face- ulceration- ulceration
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- inflammatory infitrates- inflammatory infitrates- sex- sex- histologic type- histologic type
c. treatmentc. treatment- still primarily surgical- still primarily surgical
i. in-situ - .5 to 1 cm margini. in-situ - .5 to 1 cm marginii. T1 (smaller than .76 mm) ii. T1 (smaller than .76 mm) - 1-2 cm- 1-2 cmiii. thicker lesion – 3 cm marginiii. thicker lesion – 3 cm margin- excision is up to the deep fascia- excision is up to the deep fascia
- chemotherapy- chemotherapy- palpable nodes are removed by regional - palpable nodes are removed by regional dissectiondissection