BACKGRoUND tum, (b) stratum spinosumn, (c) straturn yranulosurn, (d) tratum

As the lucidum, and finally, (e) the straturn r n e u m . Hasal cells

largest human organ, the skin in one of the most complex are
and physiologically underappreclated elements of our bodies. mitotically active, single-cell layer of the least-differentiated
Be nocytes at the base of epiderrnal structure" As kera
neath its uniform appearance, the skin demonstrates basal sells mulipd
profound they leave the basal lamina to begin their differentiation
regional variation due to the highly structured organization of u
many different cell types and dermal elements. Although primarily upward migration. In the spinous layer, keratinocytes are
together by tonofibrils and produce keratin. As these ceils
hnue
valued as a protective barrier allowing interface with our surround dri
ings, the structure and physiology of the skin is complex and
upward, they lose their mitotic ability. With
entry into the graniula
layer, cells accumulate keratohyalin granules,A In the horny
fascinating. As an environmental buffer, the skin protects against a
keratinocytes age, lose their intercellular connections, and
layer
D vast array of destructive forces: The structural integrity of the From basal layer exit to
shedding, keratinocyte transit time appro
shed
epidermis creates a semipermeable barrier to chemical absorption, imates 40 to 56 days.23
prevents fluid loss, protects against penetration of solar radiation, Melanocytes and other cellular components within the skin dr
rebufs infectious agents, and dermal durability resists physical absorption of harmful radiation. Initially derived from precurwa vilb
forces. In addition, the skin's ability to regulate body heat makes it of the neural crest, melanocytes extend dendritic
proceves upnar
the body's primary thermoregulatory organ. The relative ease of into epidermal tissues from their
position beneath the basal1
analyzing skin specimens has made the skin one of the best-studied layer.3 They number approximately one for
every 35 keratinocpes
tissues of the human body. Not only does this fascinating organ and produce melanin from tyrosine
and cysteine. Once the
form the primary focus of the subspecialties of plastic surgery and
pigmen
is packaged into melanosomes within the melanocyte cell body,
thez
dermatology, but it also has driven research in a broad number of pigment molecules are transported into the epidermis via dendriti
fields, including immunology, transplantation, and would healing. processes.7 As dendritic processes (apocopation) are sheared off
melanin is transferredto keratinocytes
via
phagocyuosis. Derzte
ANATOMY AND PHYSIOLOGY OF THE SKIN
differences in skin tone, the density of melanocytes is constant amng
D
individuals. It is the rate of melanin production, transfer to keratio
cytes, and melanosome degradation that determine the degree of skin
Anatomically, the skin may be divided into three layers: the pigmentation." Whereas people of North European ancestry have
epidermis, basement membrane, and dermis.3 With very little melanocytes that release relatively low amounts of melanin, those o
extracellular matrix (ECM), the epidermis is composed primarily
African descent demonstrate the same overall quantity of melano
of specialized cells that perform vital functions. Sandwiched be-
cytes, but with much higher melanin production. Genetically act
tween epidermal and dermal structures, the basement membrane
vated factors as well as ultraviolet (U) radiation, hormones such a
anchors these layers together. 3 This membrane fulills
many estrogen, adrenocorticotropic hormone, and melanocyte-stimulating
biologic functions, including tissue organization, growth factor
hormone, increase melanin production.7
reservoir, support of cell monolayers during tissue development,
and Cutaneous melanocytes play a critical role in neutralizing the
semipermeable selective barrier. In addition to its role in
sun's harmful rays. UV-induced damage affects the function of uno
providing soft-tissue durability, the dermis is primarily composed
of a dense ECM that provides suppressor genes, directly causes cell death, and facilitates neoplast
support for a complex network of transformation. Although a majority of solar radiation that reaches
nerves, vasculature, and adnexal structures.34 The ECM is a collec-
the Earth is UVA (315 to 400 nm), the majority of skin damage
tion of fibrous proteins and associated glycoproteins embedded in i
caused by UVB (240 to 315 nm). UVB is the major factor in
a
hydrated ground substance of glycosaminoglycans and pro- sunburn
injury, and is a known risk factor in the development of melanoma
teoglycans. These distinct molecules are organized into a highly
ordered network that is closely associated with the cells that Although UVB causes considerable DNA damage in the skin, UVA
has only recently has been shown to
produce them. In addition to providing the architectural frame damage
DNA, proteins, and
work that imparts mechanical support and lipids.-1 In addition, UV-related damage can either be potentiatd
can regulate the
viscoelasticity, the ECM by or contribute to effects of other harmful agents such as ionizing
neighboring cells, including their ability to mi- radiation, viruses, or chemical carcinogens.-*
grate, proliferate, and survive injury.245
As a durable barrier
against external forces, the skin relies on a
The Epidermis complex network of filaments to maintain cellular integrity. Interme
diate filaments, called keratins, are found within the
Composed primarily of keratinocytes, the epidermis is a dynamic, spindle layer and
multilayered composite of maturing cells. From internal to external provide flexible scaffolding that enables the keratinocyte to resist
external stress.0 Various keratins are
expressed according to
layer, the epidermis is composed of the (a) stratum germina- cyte maturation phase, and mitotically active keratinocyteskeratino
most
mainly

|KEY POINTS
1. The epidermis consists of five layers. The two most 5.
superficlal layers (the stratum corneum and luci- Hemangioma is the most common cutaneous lesion
of infancy and a large
dum) contain nonviable keratinocytes. majority spontaneously invor
lute (resolve) past the first year of
2. Collagen l provides tensile strength to the dermis patient age.
6. Basal cell carcinoma (BCC) is the most common
and epidermis of skin cancer and nodular BCC is the most
form
3. Adult dermis contains a 4:1 ratio of form of this tumor.
frequent
type ltype ll
collagen. 7. Breslow thickness is the most
4. Of the congenital skin disorders, important prognostic
only pseudoxan- variable predicting survival in those with cutaneous
thoma elasticum and cutis laxia are melanoma.
responsive to
surgical rejuvenation.