Skin

Introduction
• Integumentary system
– Consists of the skin and its accessory organs; hair, nails, and
cutaneous glands
• Inspection of the skin, hair, and nails is significant part of
a physical exam
• Skin is the most vulnerable organ
– Exposed to radiation, trauma, infection, and injurious chemicals
• Receives more medical treatment than any other organ
system
• Dermatology—scientific study and medical treatment of
the integumentary system
 Structure of the Skin

Hairs

Sweat pores
Dermal papilla
Tactile corpuscle Epidermis
(touch receptor)

Blood capillaries

Hair follicle Dermis

Sebaceous gland
Hair receptor

Apocrine sweat gland

Hair bulb Hypodermis

(subcutaneous fat)

Sensory Merocrine sweat

nerve fibers gland
Piloerector muscle Cutaneous blood
Lamellar (pacinian) vessels
corpuscle (pressure receptor)
Motor nerve fibers
The Skin and Subcutaneous Tissue

• The body’s largest and heaviest organ

– Covers area of 1.5 to 2.0 m2
– 15% of body weight
– Most skin is 1 to 2 mm thick

• Two layers
– Epidermis: stratified squamous epithelium
– Dermis: connective tissue layer
The Skin and Subcutaneous Tissue

• Hypodermis—another connective tissue layer

below the dermis
• Thick skin—on palms and sole, and corresponding
surfaces on fingers and toes
– Has sweat glands, but no hair follicles or sebaceous (oil)
glands
– Epidermis 0.5 mm thick
• Thin skin covers rest of the body
– Epidermis about 0.1 mm thick
– Possesses hair follicles, sebaceous glands, and sweat
glands
 Functions of the Skin
• Resistance to trauma
and infection
– Keratin
– Acid mantle
• Other barrier functions
– Waterproofing
– UV radiation
– Harmful chemicals
• Vitamin D synthesis
– Skin first step
– Liver and kidneys
complete process
 Functions of the Skin
• Sensation
– Skin is our most extensive sense
organ
• Thermoregulation
– Thermoreceptors
– Vasoconstriction/vasodil ation
• Nonverbal communication
– Acne, birthmark, or scar
• Transdermal absorption
– Administration of certain drugs steadily
through thin skin via adhesive patches
 The Epidermis

• Epidermis—keratinized stratified squamous

epithelium
– Dead cells at the surface packed with tough protein
called keratin
– Lacks blood vessels
– Depends on the diffusion of nutrients from underlying
connective tissue
– Sparse nerve endings for touch and pain
 Cells of the Epidermis
• Five types of cells of the epidermis
– Stem cells
• Undifferentiated cells that give rise to keratinocytes
• In deepest layer of epidermis (stratum basale)
– Keratinocytes
• Great majority of epidermal cells
• Synthesize keratin
– Melanocytes
• Occur only in stratum basale
• Synthesize pigment melanin that shields DNA from
ultraviolet radiation
• Branched processes that spread among keratinocytes
 Cells of the Epidermis
Cont.
– Tactile (Merkel) cells
• In basal layer of epidermis
• Touch receptor cells associated with dermal nerve
fibers
– Dendritic (Langerhans) cells
• Macrophages originating in bone marrow that guard
against pathogens
• Found in stratum spinosum and granulosum
• Stand guard against toxins, microbes, and other
pathogens that penetrate skin
 Cells of the Epidermis
Sweat pore
Stratum corneum
Exfoliating
Stratum lucidum
keratinocytes
Stratum granulosum

Dead keratinocytes
Sweat duct

Living keratinocytes

Dendritic cell
Stratum spinosum
Tactile cell

Melanocyte

Stem cell

Stratum basale
Dermal papilla

Tactile nerve fiber

Dermis
Dermal blood vessels
 Layers of the Epidermis

• Stratum basale
– A single layer of cuboidal to low columnar stem
cells and keratinocytes resting on the basement
membrane
– Melanocytes and tactile cells are scattered
among the stem cells and keratinocytes

• Stem cells of stratum basale divide

– Give rise to keratinocytes that migrate toward skin
surface
– Replace lost epidermal cells
 Layers of the Epidermis
• Stratum spinosum
– Produce more and more keratin filaments which
causes cell to flatten; the higher up in this stratum, the
flatter the cells appear
• Dendritic cells found throughout this stratum
• Named for artificial appearance created in
histological section
– Numerous desmosomes and cell shrinkage produces
spiny appearance
– Consists of several layers of keratinocytes
 Layers of the Epidermis
• Thickest stratum in most skin
– In thick skin, exceeded by stratum corneum

• Deepest cells remain capable of mitosis

– Cease dividing as they are pushed upward
 Layers of the Epidermis

• Stratum granulosum
– Consists of three to five layers of flat keratinocytes
– Contains coarse dark-staining keratohyalin granules
 Layers of the Epidermis
• Stratum lucidum
– Seen only in thick skin

• Thin translucent zone superficial to stratum

granulosum
• Keratinocytes are densely packed with eleidin
• Cells have no nucleus or other organelles
• Zone has a pale, featureless appearance with
indistinct boundaries
 Layers of the Epidermis

• Stratum corneum
– Up to 30 layers of dead, scaly, keratinized cells

• Form durable surface layer

– Surface cells flake off (exfoliate)

• Resistant to abrasion, penetration, and water loss

 The Life History of a Keratinocyte

• Keratinocytes are produced deep in the epidermis

by stem cells in stratum basale
– Some deepest keratinocytes in stratum spinosum also
multiply and increase their numbers

• Mitosis requires an abundant supply of oxygen

and nutrients
– Deep cells acquire oxygen from blood vessels in nearby
dermis
– Once epidermal cells migrate more than two or three
cells away from the dermis, their mitosis ceases
 The Life History of a Keratinocyte

• Newly formed keratinocytes push the older ones toward

the surface

• In 30 to 40 days a keratinocyte makes its way to the skin

surface and flakes off
– Slower in old age
– Faster in injured or stressed skin
• Calluses or corns—thick accumulations of dead
keratinocytes on the hands or feet
• Cytoskeleton proliferates as cells are shoved upward
• Produce lipid-filled membrane-coating vesicles
(lamellar granules)
 The Life History of a Keratinocyte

• In stratum granulosum three important developments

occur
– Keratinocyte nucleus and other organelles degenerate;
cells die
– Keratohyalin granules release a protein filaggrin
• Binds the keratin filaments together into coarse, tough bundles
– Membrane-coating vesicles release lipid mixture that
spreads out over cell surface and waterproofs it

• Epidermal water barrier—forms between stratum

granulosum and stratum spinosum
 The Life History of a Keratinocyte

• Consists of:
– Lipids secreted by keratinocytes
– Tight junctions between keratinocytes
– Thick layer of insoluble protein on the inner surfaces of the
keratinocyte plasma membranes

• Critical to retaining water in the body and

preventing dehydration
• Cells above the water barrier quickly die
– Barrier cuts them off from nutrients below
– Dead cells exfoliate (dander)
– Dandruff: clumps of dander stuck together by sebum (oil)
 The Dermis

• Dermis—connective tissue layer beneath the

epidermis
– Ranges from 0.2 mm (eyelids) to 4 mm (palms, soles)
– Composed mainly of collagen with elastic fibers,
reticular fibers, and fibroblasts
– Well supplied with blood vessels, sweat glands,
sebaceous glands, and nerve endings
 The Dermis

• Hair follicles and nail roots are embedded in dermis

– Smooth muscle (piloerector muscles) associated with
hair follicles
– Contract in response to stimuli such as cold, fear, and
touch—goose bumps

• Dermal papillae—upward fingerlike extensions

of the dermis
– Friction ridges on fingertips that leave fingerprints
 The Dermis

• Papillary layer—superficial zone of dermis

– Thin zone of areolar tissue in and near the dermal papilla
– Allows for mobility of leukocytes and other defense cells
should epidermis become broken
– Rich in small blood vessels

• Reticular layer—deeper and much thicker layer of

dermis
– Consists of dense, irregular connective tissue
– Stretch marks (striae): tears in the collagen fibers
caused by stretching of the skin due to pregnancy or
obesity
The Dermis
The Hypodermis
• Hypodermis
– Subcutaneous tissue
– More areolar and adipose than
dermis
– Pads body
– Binds skin to underlying
tissues
• Drugs introduced by injection
– Highly vascular and absorbs
them quickly
• Subcutaneous fat
– Energy reservoir
– Thermal insulation
– 8% thicker in women
 Skin Color

• Melanin—most significant factor in skin color

– Produced by melanocytes
– Accumulate in the keratinocytes of stratum basale
and stratum spinosum
– Eumelanin—brownish black
– Pheomelanin—a reddish yellow sulfur-containing
pigment
 Skin Color

• People of different skin colors have the same

number of melanocytes
– Dark-skinned people
• Produce greater quantities of melanin
• Melanin granules in keratinocytes more spread out than
tightly clumped
• Melanin breaks down more slowly
• Melanized cells seen throughout the epidermis
 Skin Color
Cont.
– Light-skinned people
• Melanin clumped near keratinocyte nucleus
• Melanin breaks down more rapidly
• Little seen beyond stratum basale

• Amount of melanin also varies with exposure

to ultraviolet (UV) rays of sunlight
 Skin Color
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Stratum corneum
Stratum corneum

Epidermis Epidermis

Melanized cells
of stratum basale

Dermis

(a) Dark skin (b) Light skin

© The McGraw-Hill Companies, Inc./Dennis Strete, photographer; b(inset): © Creatas/PunchStock © The McGraw-Hill Companies, Inc./Dennis Strete, photographer;
a(inset): © Tom & Dee Ann McCarthy/Corbis

• Hemoglobin—red pigment of red blood cells

– Adds reddish to pinkish hue to skin
• Carotene—yellow pigment acquired from egg yolks and
yellow/orange vegetables
– Concentrates in stratum corneum and subcutaneous fat
 Skin Color

Colors of diagnostic value

• Cyanosis—blueness of the skin from
deficiency of oxygen in the circulating blood
– Airway obstruction (drowning or choking)
– Lung diseases (emphysema or respiratory arrest)
– Cold weather or cardiac arrest

• Erythema—abnormal redness of the skin due

to dilated cutaneous vessels
– Exercise, hot weather, sunburn, anger, or
embarrassment
 Skin Color
Colors of diagnostic value
• Pallor—pale or ashen color when there is so little blood
flow through the skin that the white color of dermal
collagen is visible
– Emotional stress, low blood pressure, circulatory shock,
cold, anemia
• Albinism—genetic lack of melanin that results in white
hair, pale skin, and pink eyes
– Have inherited recessive, nonfunctional tyrosinase allele
 Skin Color
Cont.
• Jaundice—yellowing of skin and sclera due to excess of
bilirubin in blood
– Cancer, hepatitis, cirrhosis, other compromised liver
function
• Hematoma (bruise)—mass of clotted blood showing
through skin
 The Evolution of Skin Color

• Skin color—one of the most conspicuous signs of

human variation
– Results from combination of evolutionary selection
pressures
– Especially differences in exposure to ultraviolet
radiation (UVR)
 The Evolution of Skin Color

• UVR has two adverse effects

– Causes skin cancer
– Breaks down folic acid needed for normal cell
division, fertility, and fetal development
• UVR has one desirable effect
– Stimulates synthesis of vitamin D necessary for
dietary calcium absorption
 The Evolution of Skin Color

• Populations native to the tropics and their

descendants tend to have well-melanized skin to
screen out excessive UVR
• Populations native to far northern or southern
latitudes where the sunlight is weak, tend to have
light skin to allow for adequate UVR penetration
 The Evolution of Skin Color

• Ancestral skin color is a compromise between

vitamin D and folic acid requirements
• Women have skin averaging about 4% lighter than
men
– Need greater amounts of vitamin D and folic acid to
support pregnancy and lactation
 The Evolution of Skin Color

• High altitude and dry air increases skin pigmentation

– Andes, Tibet, Ethiopia

• UVR accounts for up to 77% of variation in human

skin color
• Other exceptions
– Migration, cultural differences in clothing, and shelter
– Intermarriage of people of different geographic ancestries
– Darwinian sexual selection: a preference in mate choice for
partners of light or dark complexion
 Skin Markings

• Friction ridges—the markings on the fingertips that

leave oily fingerprints on surfaces we touch
– Everyone has a unique pattern formed during fetal
development that remains unchanged throughout life
– Not even identical twins have identical fingerprints
– Allow manipulation of small objects

• Flexion lines (flexion creases)—lines on the flexor

surfaces of the digits, palms, wrists, elbows
– Marks sites where the skin folds during flexion of the
joints
 Skin Markings

• Freckles and moles—tan to black aggregations of

melanocytes
– Freckles are flat, melanized patches
– Moles (nevus) are elevated melanized patches often with
hair
• Moles should be watched for changes in color, diameter, or
contour
• May suggest malignancy (skin cancer)

• Hemangiomas (birthmarks)—patches of
discolored skin caused by benign tumors of dermal
blood capillaries
– Some disappear in childhood, others last for life
– Capillary hemangiomas, cavernous hemangiomas, port-
wine stain
 Hair and Nails
• Expected Learning Outcomes
– Distinguish between three types of hair.
– Describe the histology of a hair and its follicle.
– Discuss some theories of the purposes served by
various kinds of hair.
– Describe the structure and function of nails.
 Hair and Nails

• Hair, nails, and cutaneous glands are accessory

organs of the skin
• Hair and nails are composed of mostly dead, keratinized
cells
– Pliable soft keratin makes up stratum corneum of skin
– Compact hard keratin makes up hair and nails
• Tougher and more compact due to numerous cross-
linkages between keratin molecules
 Hair and Nails

• Pilus—another name for hair; pili—plural of pilus

• Hair—a slender filament of keratinized cells that
grows from an oblique tube in the skin called a hair
follicle
 Hair

• Hair is found almost everywhere on the body

except:
– Palms and soles
– Ventral and lateral surfaces of fingers and toes
– Distal segment of the finger
– Lips, nipples, and parts of genitals
 Hair

• Limbs and trunk have 55 to 70 hairs per cm2

– Face about 10 times as many
– 30,000 hairs in a man’s beard
– 100,000 hairs on an average person’s scalp
– Number of hairs does not differ much from person to
person or even between sexes
• Differences in appearance due to texture and pigmentation
of the hair
 Hair
• Three kinds of hair grow over the course of our lives
– Lanugo: fine, downy, unpigmented hair that appears on
the fetus in the last 3 months of development
– Vellus: fine, pale hair that replaces lanugo by time of birth
• Two-thirds of the hair of women
• One-tenth of the hair of men
• All of hair of children except eyebrows, eyelashes, and hair
of the scalp
 Hair
Cont.
– Terminal: longer, coarser, and usually more heavily
pigmented
• Forms eyebrows, eyelashes, and the hair of the scalp
• After puberty, forms the axillary and pubic hair
• Male facial hair and some of the hair on the trunk and limbs
 Structure of the Hair and Follicle
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• Hair is divisible into three

zones along its length
– Bulb: a swelling at the
Hair shaft
base where hair originates
in dermis or hypodermis
• Only living hair cells are
in or near bulb
Sebaceous
gland
Piloerector
muscle – Root: the remainder of the
Hair receptor
Hair root
Bulge
Hair matrix
hair in the follicle
Apocrine
Hair bulb
– Shaft: the portion above
the skin surface
sweat gland Dermal
papilla
Blood
capillaries
in dermal
papilla
 Structure of the Hair and Follicle

• Dermal papilla—bud of
vascular connective tissue
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encased by bulb Connective

tissue

– Provides the hair with its sole root sheath

source of nutrition
Epithelial root
sheath

Hair medulla

• Hair matrix—region of Hair cortex

mitotically active cells Hair matrix

Hair bulb

immediately above papilla Dermal

papilla

– Hair’s growth center

(b) 0.5 mm
Structure of the Hair and Follicle
• Three layers of the hair in cross section from
inside out
– Medulla
• Core of loosely arranged cells and air spaces
– Cortex
• Constitutes bulk of the hair
• Consists of several layers of elongated keratinized cells
– Cuticle
• Composed of multiple layers of very thin, scaly cells that
overlap each other
• Free edges directed upward
 Structure of the Hair and Follicle
• Follicle—diagonal tube that dips deeply into
dermis and may extend into hypodermis
– Epithelial root sheath
• Extension of the epidermis
• Lies immediately adjacent to hair root
• Toward deep end widens into bulge—a source of stem cells
for follicular growth
– Connective tissue root sheath
• Derived from dermis
• Surrounds epithelial root sheath
• Denser than adjacent connective tissue
Structure of the Hair and Follicle
• Hair receptors
– Nerve fibers that entwine each follicle
– Respond to hair movement

• Piloerector muscle (arrector pili)

– Bundles of smooth muscle cells
– Extends from dermal collagen to connective tissue root sheath
– Goose bumps
 Hair Texture and Color
• Texture—related to differences in cross-sectional
shape
– Straight hair is round
– Wavy hair is oval
– Curly hair is relatively flat

• Color—due to pigment granules in the cells of the

cortex
– Brown and black hair is rich in eumelanin
– Red hair has a slight amount of eumelanin but a high
concentration of pheomelanin
– Blond hair has an intermediate amount of pheomelanin
and very little eumelanin
– Gray and white hair results from scarcity or absence of
melanin in the cortex and the presence of air in the
medulla
 Hair Texture and Color
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Eumelanin

Pheomelanin

Cuticle

Cortex

(c) Red, wavy Air

space
Eumelanin
Pheomelanin

Medulla
(b) Black, straight
(a) Blond, straight (d) Gray, wavy
 Hair Growth and Loss
• Hair cycle—consists of three developmental stages
– Anagen: growth stage, 90% of scalp follicles at any given
time
• Stem cells multiply and travel downward
• Pushing dermal papilla deeper into skin, forming epidermal
root sheath
• Root sheath cells directly above dermal papilla form the hair
matrix
• Sheath cells transform into hair cells, synthesize keratin, and
die as they are pushed upward
• New hair grows up the follicle, often alongside of an old club
hair from the previous cycle
 Hair Growth and Loss
Cont.
– Catagen: degenerative stage, mitosis in the hair matrix
ceases and sheath cells below the bulge die
• Follicle shrinks and dermal papilla is drawn up toward the
bulge
• Base of hair keratinizes into a hard club—club hair
– Loses its anchorage
– Easily pulled out by brushing
– Telogen: resting stage, when papilla reaches the bulge
 Hair Growth and Loss

• Club hair may fall out during catagen or telogen

– Or, be pushed out by new hair in the next anagen phase
– We lose about 50 to 100 scalp hairs daily
– In young adults, the scalp follicles spend 6–8 years in anagen,
2–3 weeks in catagen, 1–2 months in telogen

• Hair growth—scalp hairs grow at a rate of 1 mm

per 3 days (10–18 cm/yr)
• Alopecia—thinning of the hair or baldness

57
 Hair Growth and Loss

• Pattern baldness—the condition in which hair loss

occurs from specific regions of the scalp rather than
thinning uniformly
– Combination of genetic and hormonal influence
– Baldness allele is dominant in males and expressed only
in high testosterone levels
– Testosterone causes terminal hair in scalp to be replaced
by vellus hair

• Hirsutism—excessive or undesirable hairiness in

areas that are not usually hairy
 The Hair Cycle

Old club hair

Epidermis
Sebaceous
gland Club hair
(detached
Piloerector from matrix)
New hair
Club
Bulge
Hair matrix
Hair bulb Degeneration
of lower follicle
Dermis
Dermal papilla

1 Anagen (early) Anagen (mature) 2 Catagen 3 Telogen

(Growing phase, 6–8 years) (Degenerative phase, 2–3 weeks)
(Resting phase, 1–3 months)
Stem cells multiply and follicle grows deeper into dermis; hair matrix Hair growth ceases; hair bulb
Dermal papilla has ascended
cells multiply and keratinize, causing hair to grow upward; old club keratinizes and forms club hair;
to level of bulge; club hair falls
hair may persist temporarily alongside newly growing hair. lower follicle degenerates.
out, usually in telogen or
next anagen.
 Functions of Hair

• Most hair on trunk and limbs is vestigial

– Little present function
– Warmth in ancestors
• Hair receptors alert us of parasites crawling on skin
• Scalp helps retain heat and protects against
sunburn
• Pubic and axillary hair signify sexual maturity and
aid in transmission of sexual scents
• Guard hairs (vibrissae)
– Guard nostrils and ear canals
• Eyelashes and eyebrows
– Nonverbal communication
 Nails
• Fingernails and toenails—clear, hard
derivatives of the stratum corneum
– Composed of very thin, dead cells packed with hard
keratin
• Flat nails allow for more fleshy and sensitive
fingertips
– Tools for digging, grooming, picking apart food, and
other manipulations
• Nail plate—hard part of the nail
– Free edge: overhangs the fingertip
– Nail body: visible attached part of nail
– Nail root: extends proximally under overlying skin
Fingernail Structure

Free edge

Nail body

Nail groove
Nail fold
Lunule

Eponychium
(cuticle)

Nail
Nail plate root Nail fold

Free Nail Eponychium

edge body (cuticle)

Nail bed Nail matrix

 Nails

• Nail fold—surrounding skin rising a bit above the

nail
• Nail groove—separates nail fold from nail plate
• Nail bed—skin underlying the nail plate
• Hyponychium—epidermis of the nail bed
 Nails
• Nail matrix—growth zone of thickened stratum
basale at the proximal end of nail
– Mitosis here accounts for nail growth
– 1 mm per week in fingernails, slightly slower on toenails

• Lunule—an opaque white crescent at proximal

end of nail
• Eponychium (cuticle)—narrow zone of dead
skin that commonly overhangs this end of the nail
 Cutaneous Glands
• Expected Learning Outcomes
– Name two types of sweat glands, and describe the
structure and function of each.
– Describe the location, structure, and function of
sebaceous and ceruminous glands.
– Discuss the distinction between breasts and
mammary glands, and explain their respective
functions.

65
 Sweat Glands
Lumen Secretory Myoepithelial Lumen
cells cells
Gland Hair follicle
Secretory cells

(c) Sebaceous gland

© The McGraw-Hill Companies, Inc./Joe DeGrandis, photographer

(a) Apocrine gland

© The McGraw-Hill Companies, Inc./Joe DeGrandis, photographer
(b) Merocrine gland
© The McGraw-Hill Companies, Inc./Joe DeGrandis, photographer

•The skin has five types of glands: merocrine sweat glands,

apocrine sweat glands, sebaceous glands, ceruminous glands,
and mammary glands
 Sweat Glands

• Two kinds of sweat (sudoriferous) glands

– Merocrine (eccrine) sweat glands
• Most numerous skin glands—3 to 4 million in adult skin
• Simple tubular glands
• Watery perspiration that helps cool the body
• Myoepithelial cells—contract in response to stimulation
by sympathetic nervous system and squeeze perspiration
up the duct
 Sweat Glands
Cont.
– Apocrine sweat glands
• Occur in groin, anal region, axilla, areola, bearded area in
mature males
• Ducts lead to nearby hair follicles
• Produce sweat that is thicker, milky, and contains fatty
acids
• Scent glands that respond to stress and sexual stimulation
• Develop at puberty
• Pheromones—chemicals that influence the physiology of
behavior of other members of the species
• Bromhidrosis—disagreeable body odor produced by
bacterial action on fatty acids
 Sweat Glands
• Sweat—begins as a protein-free filtrate of blood
plasma produced by deep secretory portion of gland
– Potassium ions, urea, lactic acid, ammonia, and some
sodium chloride remain in the sweat, most sodium
chloride reabsorbed by duct
– Some drugs are also excreted in sweat
– On average, 99% water, with pH range of 4 to 6
• Acid mantle—inhibits bacterial growth

– Insensible perspiration—500 mL/day

• Does not produce visible wetness of skin
– Diaphoresis—sweating with wetness of the skin
• Exercise—may lose 1 L sweat per hour
 Sebaceous Glands
• Sebum—oily secretion produced by sebaceous
glands
• Flask-shaped glands with short ducts opening into
hair follicle
• Holocrine gland—secretion consists of broken-
down cells
– Replaced by mitosis at base of gland
• Keeps skin and hair from becoming dry, brittle,
and cracked
• Lanolin—sheep sebum
 Ceruminous Glands

• Found only in external ear canal

• Their secretion combines with sebum and dead
epithelial cells to form earwax (cerumen)
– Keeps eardrum pliable
– Waterproofs the canal
– Kills bacteria
– Makes guard hairs of ear sticky to help block foreign
particles from entering auditory canal
• Simple, coiled tubular glands with ducts that lead
to skin surface
 Mammary Glands
• Breasts (mammae) of both sexes contain very little
glandular material
• Mammary glands—milk-producing glands that develop
only during pregnancy and lactation
– Modified apocrine sweat gland
– Richer secretion released by ducts opening into the nipple

• Mammary ridges or milk lines

– Two rows of mammary glands in most mammals
– Primates kept only anteriormost glands

• Additional nipples (polythelia)

– May develop along milk line
 Skin Disorders
• Expected Learning Outcomes
– Describe the three most common forms of skin
cancer.
– Describe the three classes of burns and the priorities
in burn treatment.
 Skin Cancer
• Skin cancer—induced by the UV rays of the sun
– Most often on the head and neck
– Most common in fair-skinned people and the elderly
– One of the most common cancer
– One of the easiest to treat
– Has one of the highest survival rates if detected and
treated early
• Three types of skin cancer named for the
epidermal cells in which they originate
– Basal cell carcinoma, squamous cell carcinoma, and
malignant melanoma
 Skin Cancer
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

(a) Basal cell carcinoma

© NMSB/Custom Medical Stock Photo, Inc.

• Basal cell carcinoma

- Most common type
- Least dangerous because it seldom metastasizes
- Forms from cells in stratum basale
- Lesion is small, shiny bump with central depression and beaded edges
 Skin Cancer

(b) Squamous cell carcinoma

© Biophoto Associates/Photo Researchers, Inc.

• Squamous cell carcinoma

- Arise from keratinocytes from stratum spinosum
- Lesions usually appear on scalp, ears, lower lip, or back of the hand
- Have raised, reddened, scaly appearance later forming a concave ulcer
- Chance of recovery good with early detection and surgical removal
- Tends to metastasize to lymph nodes and may become lethal
 Skin Cancer

(c) Malignant melanoma

• Malignant melanoma
- Skin cancer that arises from melanocytes; often in a preexisting
mole
- Less than 5% of skin cancers, but most deadly form
- Treated surgically if caught early
- Metastasizes rapidly; unresponsive to chemotherapy; usually fatal
 Skin Cancer
Cont.
- Person with metastatic melanoma lives only 6 months
from diagnosis
- 5% to 14% survive 5 years
- Greatest risk factor: familial history of malignant
melanoma
- High incidence in men, redheads, people who
experience severe
- sunburn in childhood
 Burns
• UVA and UVB are improperly called ―tanning raysǁ
and ―burning raysǁ
– Both thought to initiate skin cancer
• Sunscreens protect you from sunburn but unsure if
they provide protection against cancer
– Chemical in sunscreen damage DNA and generate
harmful free radicals
• Burns—leading cause of accidental death
– Fires, kitchen spills, sunlight, ionizing radiation, strong
acids or bases, or electrical shock
– Deaths result primarily from fluid loss, infection, and toxic
effects of eschar (burned, dead tissue)
– Debridement: removal of eschar
 Burns

• Classified according to the depth of tissue

involvement
– First-degree burn: partial-thickness burn; involves only
the epidermis
• Marked by redness, slight edema, and pain
• Heals in a few days
• Most sunburns are first-degree burns
 Burns

Cont.
– Second-degree burn: partial-thickness burn; involves
the epidermis and part of the dermis
• Leaves part of the dermis intact
• Red, tan, or white
• Two weeks to several months to heal and may leave scars
• Blistered and very painful

– Third-degree burn: full-thickness burn; the epidermis and

all of the dermis, and often some deeper tissues
(muscles or bones) are destroyed
• Often requires skin grafts
• Needs fluid replacement and infection control
 Degrees of Burn Injuries
Partial-thickness burns Full-thickness burns

(a) First degree (b) Second degree (c) Third degree

a: © SPL/Custom Medical Stock Photo, Inc.; b-c: © John Radcliffe/Photo Researchers, Inc.
 Skin Grafts and Artificial Skin

• Third-degree burns require skin grafts

• Graft options
– Autograft: tissue taken from another location on the same
person’s body
• Split-skin graft—taking epidermis and part of the dermis
from an undamaged area such as the thigh or buttocks and
grafting it into the burned area
– Isograft: skin from identical twin
 Skin Grafts and Artificial Skin

• Temporary grafts (immune system rejection)

– Homograft (allograft): from unrelated person
– Heterograft (xenograft): from another species
– Amnion from afterbirth
– Artificial skin from silicone and collagen