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Lux Aeterna M.D.

The Integumentary System

Dr. Roberto Alfabeto
August 11, 2008
Note Takers: Christian, Dayan, Ryge, Rose
"Dont take life too seriously, besides no comes out of it Alive
I. The Integument
Epidermis or Cuticle
Dernis or true skin
Function of the skin
- Protection from the external environment
- Sense organ
- Thermoregulation
- Excretory and Asoring activity
- !ole in Fat "etaolism
II. Skin Develoment
Ectoderm # epidermis and appendages
"esoderm # dermis
%eek # & layers of epidermis
month # nails formed
to (
month # hair development
month # sucutaneous fat and s%eat glands develop
month # head has fetal hair )lanugo*
month # dermal papilla and nails pro,ect out
-ernix caseosa )sucutaneous secretion %hich makes the ay.s skin to e slimy during the delivery*
III. !i"ermis
Cuticle or Scarf Skin
/on vascular
Stratified S0uamous Epithelium
Thickness varies
Flexure 1ines # or ridges2 dermal papilla %hich functions in3
Deeper in non hairy surfaces
I#. $ayers of Stratifie" S%uamous !ithelium &in the !i"ermis' arrange" from the "eeest layer going u(
Stratum "alphighii
- Stratum 4asale
- Deepest layer2 also called Stratum Cylindricum and Stratum germinatuvum; supplies ne% cells
)keratinocyte5 melanocyte and markel cells*2 contains melanin
- Stratum Spinosum
- Polygonal cells2 desmosomes )connection et%een cells*2 spike-like2 contains $angerhan)s *ells )dendritic
cells %hich act like macrophages*2 contains tonofibrils
Stratum granulosum
- '-$ ro%s of flattened cells
- 6eratohyaline granules
- Associated %ith +eratini,ation ro*ess
- 1ipid filled memerane # coating vesicles
- 7ranules are asent in nails
Caution: Dont take the original copy or youre
Stratum 1ucidum
- homogenous translucent and
- cells %ith no nucleus
- droplets of elei"in
- asent in thin skin

Stratum Corneum
- scales or plates
- cells %ith no nucleus
- 6eratin replaces the cytoplasm
- Stratum dis,unction # des0uamated cells
#. !i"ermis &*hara*teristi*s(
Color of skin depends on the pigments
"elanin5 carotene and hemogloin are the pigments found on the epidermis
"ain purpose is for protection
Cytomorphosis8 9$ # ': days
#I. -ells in the !i"ermis
1angerhan Cells # phagocytosis );*
"erkel Cells
#II. .elono*yte System
Color Components
- Carotene
- <xyhemogloin
- "elanin
"elanocytes - sole producer of melanin
Tyrosinase # en=yme for synthesis of pigment from tyrosine
Cytocrine # process of transfer of melanin granules from melanocyte to "alphigian cells
#III. Dermis
Corium cutis vera5 true skin
Tough5 flexile5 elastic
Thickness varies
Contains lood vessels and nerves
& layers of connective tissue8
- /aillary $ayer
- Superficial layer
- Papilla # conical5 sensitive and vascular eminence
- Arranged in parallel lines and ridges in palms and soles
- Sudoriferous duct open on top of the ridges
- Reti*ular $ayer
- deep layer
- dense firoelastic connective tissue
- contains smooth muscles
- arrector pili muscle
- muscle of facial expression
- Panniculus carnosus
Caution: Dont take the original copy or youre
I0. -leavage $ines
1anger.s 1ines
Parallel %ith Collagen fiers
Tension 1ines
Surgical incision
0. Aen"ages of the Skin
A> /ails
?orny Plate
/ail 4ed
/ail %all
/ail groove
Divided into three parts8
9> !oot
- nail matrix
- lunula
&> 4ody
- Thickened stratum lucidum
- Eponychium # stratum corneum
- Elongates ecause of stratum germinativum of root
- Thickens ecause of stratum germinativum of lunula
'> Free Edge
- <verlies the hyponychium
4> ?air
Asent in palms5 soles5 dorsal terminal phalanges5 glans penis prepuce5 laia
-ary in thickness
Straight hair is stronger than curly hair
Parts of ?air
1. 1air Root
- hair ul
- seaceous gland openine
- hair folli*le8 dermis and epidermis coat
<uter coat # firous and vascular
@nner coat # is made up of outer and inner
root sheath8
- Cuticle # next to the hair
- ?uxley.s layer # horny5 flattenes
- ?enle.s layer # cuoidal
2. 1air Shaft
- asent in fine hair
- granules of eleidin and air spaces
- Chief part
- melanin5 air space
- @mricated scales
/igmentation of the Skin
- ?air color is caused y a pigment )melanin* that is produced y
the hair follicle> Aith aging5 the follicle produces less melanin5 eumelanin and pheomelanin>
- found at the tip of dermal papilla
- melanosomes are larger than skin
Caution: Dont take the original copy or youre
$aser Removal of 1air
Three Stages of ?air gro%th
9> Anagen # active gro%th phase
&> Catagen # regression phase %hen the lo%er part of the hair stops gro%ing
ut is not shed
'> Telogen # the final stage> This is the resting phase %hen the hair falls out in
preparation of ne% haor gro%th>
The most effe*tive treatment o**urs "uring the Anagen hase 2hen
the hair *ontains an abun"an*e of melanin.
C> Seaceous 7lands
Consist of single duct from a cluster of alveoli
Seum cuntaneum
<pen in the hair follicle except in 1aia minora and lips
"eiomian glands # largest seaceous glands
D> Suderiferous 7lands
S%eat 7lands
<pens on the surface of the skin
-aries %ith race
Asent on deep auditory meatus5 prepuce and glans penis
B:: # C:: grams # average 0uantity
1ayers8 <uter areolar layer and Epithelium
"odified S%eat 7lands8
Ceruminous glands # ears
Ciliary glands # eyes
Circumanal glands
"ammary glands
Tale 98 Comparison of Exocrine and Apocrine S%eat 7lands
3eature !4o*rine 5lan"s Ao*rine 5lan"s
Distriution Througout the ody
Axilla5 groin5 areola and earded
areas of the face
1ocation of Secretory Portion Surface of the dernis ?air Follicles
Secretion 1ess viscous "ore -iscous
!egulation of ody
Stimulated during emotional stress
and sexual excitement
<nset of Fuction Througout the ody Puerty
0I. 6asal -ell -ar*inoma
@t is the most common skin cancer
/odolystic or noduloulcerative type accounts for B: percent of asal cell carcinomas
!odent Dlcers
Pigmented asal cell carcinomas are tan to lack color and should e distinguished y iopsy examination
from melanoma
Superficial 4asal Cell Cancers occur more commonly on the trunk and turn red5 scaling lesion sometimes
difficult to distinguish grossly from 4o%en.s disease
4asos0uamous types are rare asal cell carcinoma> These lesions can metastasi=e more like a s0uamous
cell carcinoma and should e treated aggressively
"orpheaform5 adenoid and infiltrative carcinomas
Caution: Dont take the original copy or youre
Excision %ith a &- to (- mm margin
0II. S%uamous -ell -ar*inomas
Arise from keratinocytes
@nvade surrounding tissue and metastasi=e more readily
4o%en.s disease # in situ
S0uamous cell carcinomas of the penis are referred to as !rythrolasia of 7ueyrat
Tumor thickness correlates %ell %ith its iologic ehavior
0III. .alignant .elanoma
Arises from transformed melanocytes and can arise any%here that melanocytes have migrated during
Superficial spreading
- most common type )B:E*
- 1ong radial gro%th phase efore vertical gro%th egin
- 9$ to &: percent of melanomas
- The histologic criterion is the lack of radial gro%th peripheral to the area of vertical gro%th
1entigo "aligna
- $E-9:E of melanomas
- surrounded y dermis %ith heavy solar degeneration
- est prognosis ecause invasive gro%th occurs late
Acral 1entiginous
- Palms and soles and in the sulingual regions
0I#. In"een"ent /rognosti* 3a*tor
Anatomic 1ocation
?istologic type # 1entigo maligna types have a etter prognosis and acral lentiginous lesions have the %orse
0#. Treatment
Excisional 4iopsy
@ncisional 4iopsy
@n situ lesions a :>$ to 9 cm margin of normal skin ade0uate for cure
T9 melanoma )less than :>B+ mm deep* re0uires 9 cm margin to prevent the local recurrence>
For thicker lesions a &-' cm margin is recommended
Skin graft or flap
All clinically positive lymph nodes should e removed y regional nodal dissection
Sentinel node iopsy
@ntravenous interferon alpha & )@/F alpha # &* in patients %ith lesions of (mm or more )T(* or nodal
mestastasis )/9*
Figure 9> "alignant "elanoma Classification ased on the depth of invasion
Caution: Dont take the original copy or youre
Caution: Dont take the original copy or youre