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Learning objectives To understand: The structure and functional properties of skin • The classi /f_i cation of vascular skin lesions • The cutaneous manifestations of generalised disease as • related to surgery Learning objectives To understand: The structure ...

Necrotising fasciitis Meleney’s synergistic gangrene and Fournier’s gangrene are variants of a similar disease process. Necrotising fasciitis results from synergistic polymicrobial infection, most commonly a group A β -haemolytic Streptococcus in combination ...

PATHOPHYSIOLOGY OF THE SKIN AND SUBCUTANEOUS TISSUES Radiation damage UVR and ionising radiation (IR) damage cellular DNA via the tumour suppressor gene p53 , inhibiting cellular repair and apoptotic mechanisms. There is also evidence that e ff erent immune res...

PATHOPHYSIOLOGY OF THE SKIN AND SUBCUTANEOUS TISSUES Radiation damage UVR and ionising radiation (IR) damage cellular DNA via the tumour suppressor gene p53 , inhibiting cellular repair and apoptotic mechanisms. There is also evidence that e ff erent immune res...

Pilomatrixoma (calcifying epithelioma of Malherbe) These are benign hair matrix cell tumours that often calcify; 40% are found in the under-10 age group. Josef Jadassohn , 1863–1936, dermatologist, Breslau, Germany (now Wroc ł aw , Poland). Desire M Bournevil...

Premalignant lesions Extramammary Paget’s disease (intraepidermal adenocarcinoma) This occurs in cutaneous sites that are rich in apocrine glands such as the axillae and the genital and perianal regions. Approximately 25% are associated with an underlying Sir ...

Premalignant lesions Extramammary Paget’s disease (intraepidermal adenocarcinoma) This occurs in cutaneous sites that are rich in apocrine glands such as the axillae and the genital and perianal regions. Approximately 25% are associated with an underlying Sir ...

Premalignant lesions Extramammary Paget’s disease (intraepidermal adenocarcinoma) This occurs in cutaneous sites that are rich in apocrine glands such as the axillae and the genital and perianal regions. Approximately 25% are associated with an underlying Sir ...

Purpura fulminans This is a relatively rare condition in which intravascular throm - bosis produces rapid skin necrosis and haemorrhagic infarc - tion, which progresses rapidly to septic shock and disseminated intravascular coagulation. Usually seen in childre...

SKIN TUMOURS Benign lesions Basal cell papilloma (seborrhoeic keratosis, senile keratosis, verruca senilis) Their appearance varies from macular to soft, excrescent, warty lesions – often pigmented and hyperkeratotic – but may be flesh-coloured or pink. They ar...

Skin adnexa Adnexal structures such as hair follicles, sebaceous glands and sweat glands span both the epidermal and dermal layers and - contain some keratinocytes in their ducts. In injuries where epidermis is lost, re-epithelialisation occurs from these str...

Skin and soft-tissue cysts Milia Small, hard, keratin retention cysts ( Figure 45.11 ) seen both in babies and, after chronic sun exposure, in the elderly as part of Favre–Racouchot syndrome (solar comedones, pseudocysts and leathery , furrowed sun-damaged sk...

Skin dimensions The skin is a large organ. In an adult it may have an area of 2 1–2 /uni00A0 m and weigh 15–20 /uni00A0 kg. Skin thickness varies with age, location and sun damage, but in any given region it is thinner in children than in adults. The dermis is...

Sweat glands Cystadenoma (hydrocystadenomas, hidradenomas) These are 1- to 3-cm translucent blue cystic nodules. Figure 45.25 Adenoma sebaceum (courtesy of St John’s Institute for Dermatology, London, UK). Figure 45.26 Rhinophyma (courtesy of St John’s Institu...

VASCULAR LESIONS Congenital: haemangiomata and vascular malformations These can be subclassified biologically into vascular tumours or vascular malformations based on their endothelial charac - teristics, or radiologically into haemangiomata, vascular and lymph...

VASCULAR LESIONS Congenital: haemangiomata and vascular malformations These can be subclassified biologically into vascular tumours or vascular malformations based on their endothelial charac - teristics, or radiologically into haemangiomata, vascular and lymph...

WEBSITE ADDRESSES American Joint Committee on Cancer for TNM classifications of tumours and up-to-date staging: https://cancerstaging.org/. Dermnet New Zealand – a reliable online educational resource run by a community of dermatologists and other health speci...