SkinMoles, papules and tumours

Goadsby&Rutherford 2015

Q: Why has Nick gone to Oxford???

With special thanks to Nicholas James Durbin Gould for the presentation slides.

What are the 4 functions of skin?

• Protection• Sensation• Thermoregulation• Metabolic function

Q: From where does the word ‘skin’ originate?

c.1200, "animal hide" (usually dressed and tanned), from Old Norse skinn "animal hide, fur," from Proto-Germanic *skintha- (cognates: Old English scinn (rare), Old High German scinten, German schinden "to flay, skin;" German dialectal schind "skin of a fruit," Flemish schinde "bark"), from PIE *sken- "to cut off" (cognates: Breton scant "scale of a fish," Irish scainim "I tear, I burst"), from root *sek- "to cut" (see section (n.)).

Skin – what are the 4 layers

• Epidermis• Basement membrane• Dermis• Subcutaneous tissue• (insulation/lipid store)

Layers of epidermis

• What are the 5 layers?• Stratum corneum• Stratum lucidum (only in thick

skins eg soles of feet)• Stratum granulosum• Stratum spinosum• Stratum basale

Structure of epidermis

• Keratinised, stratified squamous epithelium• Cells• Keratinocytes (all layers – secrete keratin, cytokines and anti-microbial ABs)• Melanocytes (basal layer – secrete melanin)• Merkel cells (basal layer – light touch sensation)• Langerhans cells (stratum spinosum – antigen presenting cells)• Sentinel macrophages and neutrophils

Q: Who is sitting next to their ex-husband in this photo? Clue – her father was a lawyer involved in a famous caseQ: What skin condition which can be triggered by stress did she suffer from?

“People don’t understand the pressure on me to look perfect…imagine what the tabloids would do to me if they saw all these spots?”

Psoriasis – chronic inflammatory, hyperproliferative skin disease characterised by well defined erythematous scaly plaques. Davidson’s, 2014

Keratinocytes

• 90% of epidermal cells are keratinocytes• Grouped into

• Basal cells in basal layer• Squamous cells in suprabasal layers

• They are formed in the basal layer of skin as basal cells and migrate upwards over the course of a month, before being shed as squamous cells in the stratum corneum• In the basal layer: secrete keratin filaments giving skin a cytoskeleton• In granular layer: secrete lipids for semi-permeable barrier• In stratum corneum: lose their nuclei and become surrounded by a

tough impermeable envelope

This is a singer with a five-octave vocal range suffers from a skin condition characterised by facial redness, bumps, irritation and pimples – who is she? Diagnosis?

Rosacea – chronic inflammatory condition affects the central face and consists of flushing, erythema, papules and pustules . Davidson’s, 2014

Dermis

• Hair follicle: keratinocyte downgrowth from epidermis to dermis• Sebacious gland: exocrine glands

secreting sebum to lubricate and waterproof skin and hair• Sweat glands

Dermis is formed from elastin and collagen in ground substance

TermsIt’s this man’s birthday today. Who is he? And what did he invent? (Clue: it’s a food product which has proved useful to generations of students)

Inventor of Instant Noodles Momofuku Ando in 1958 due to food shortages in post war Japan.

Lesion Size? Flat or raised? Solid or Fluid-filled?

Macule <5mm Flat No

Patch >5mm Flat No

Papule <5mm Raised Solid

Plaque >5mm Raised – palpable flat lesion

Solid

Nodule >5mm Raised Solid

Vesicle <5mm Raised Fluid-filled

Bulla >5mm Raised Fluid-filled

Pustule Any Raised Contains pus(polymorphonuclear leucocytes)

Basal cell carcinoma of the skin

• Most common skin cancer• Risk factors: UV light,

immunosuppression, inherited defects in DNA repair eg Gorlin’s syndrome• Very slow grower• Will not metastasise• Will cause local tissue destruction• Basal cell carcinomas can be

superficial or nodular

Squamous cell carcinoma of the skin

• 2nd most common type of skin cancer• Risk factors: male, sun exposure, chronic healing (ulcer/burn),

immunosuppression, occupational exposure (oil, tar, ionising radiation)• Relatively high risk of metastasis, related to thickness of lesion• Presents as non-healing ulcer/growth in one of the higher sun-risk areas

• Can appear as • firm, red nodule• A flat sore with a scaly crust• A new sore or raised area on an old scar or ulcer• A red, raised patch or wart-like sore • A small nodule that enlarges and the centre becomes necrotic and sloughs.

Melanocytic lesions

• Definition: Lesion of cells differentiating towards melanocytes• Divided into 3 categories• Benign• Borderline eg dysplastic• Malginant melanoma (in situ or invasive)

• Risk factors: history of sunburn, UV light exposure, abundant naevi

Shitala, ( Hindi: “She Who Is Cool”) Indian goddess of smallpox and of other infectious diseases. She is worshipped under this name throughout the regions of South Asia in which Indo-Aryan languages are spoken. In India she is widely worshipped in the rural areas of West Bengal state.

5 points of a macroscopic assessment of a mole indicating malignancy• A - assymetry• B – border (poorly defined)• C – colour (2+ shades)• D – diameter (>6mm)• E – evolution

5 stages of melanoma

• 0 – confined to epidermis• 1 – tumour is <1mm deep with ulceration or 0.5mm deep without• 2 – tumour is 1-4mm deep with ulceration or >4mm deep without• 3 – tumour has spread to lymph nodes• 4 – tumour has spread to other organs

Can you describe the lesion?

Atopic Eczema

• Patch(Can present in many different ways)

N.B. Eczema aka dermatisis

Can you describe the lesion?

Psoriasis

• Scaly patches/papules/plaques

• Often describe as “silvery plaques”

Can you describe the lesion?

Impetigo (non-bullous)

• Plaque (palpable flat lesion)• Begins as pustules

• Golden crust – Staphylococcal infection