Skin structure 2

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The above video provides an overview of skin biology. All the details relevant to skin cancer are outline below. I suggest watching the video before reading the text. More text is here and it goes on and on and on and on just like this OK?

With the index finger and and the thumb of your left hand pinch a fold of skin on the lower inner forearm of your right arm. If you are careful you can roll your finger and thumb such that the underlying fat (subcutis) is not included. If you measure this fold of skin with some callipers it will measure ~ 2-2.5mm. This fold is of course twice the thickness of a single layer of skin so, at this anatomical site, skin measures around 1.25mm thick.

Two anatomical components unequal in thickness contribute to this single layer of skin at this site. The epidermis is the outermost layer, and is very thin but highly cellular, measuring around 50-100 microns (i.e. 50/1000 of one mm), extending as far as the basement membrane (Figure XX). Underneath the epidermis and separated from it by the basement membrane is the dermis which comprises the remaining bulk of the skin thickness (~1.25mm). Skin cancer is almost entirely a disease of the outer 50-100 micron epidermis.

Epidermis

The epidermis sits on, and is separated from the dermis, by the acellular basement membrane. Most cells within the epidermis are either:

• Keratinocytes: Most (>90%) of the cells in the epidermis are keratinocytes, ectodermal derived cells, so named because they produce a range of proteins called keratins. Most common skin cancers are derived from keratinocytes
• Melanocytes: neural crest derived cells that produce melanin. Melanin protects against most types of skin cancer by reducing the harmful effects of sunshine. Malignancy of melanocytes is known as melanoma (or malignant melanoma). Most fatal skin cancers are melanomas.
• Langerhans’ cells: bone marrow derived antigen presenting cells. The immune system is important in skin carcinogenesis although the exact contribution Langerhans’ cells make to this process is not clear.

The epidermis is a stratified squamous epithelium. Stratified because it contains multiple layers and squamous reflecting that most of the cells are wider than they are tall. It comprises the following layers (moving from deep to superficial):

• Basal layer (aka stratum basale)
• Spindle cell layer (aka prickle cell layer or stratum spinosum)
• Granular cell layer (aka stratum granulosum)
• Stratum corneum (horny cell layer)

A quick primer of skin anatomy

With the index finger and and the thumb of your left hand pinch a fold of skin on the lower inner forearm of your right arm. If you are careful you can roll your finger and thumb such that the underlying fat (subcutis) is not included. If you measure this fold of skin with some callipers it will measure ~ 2-2.5mm. This fold is of course twice the thickness of a single layer of skin so, at this anatomical site, skin measures around 1.25mm thick.

Two anatomical components unequal in thickness contribute to this single layer of skin at this site. The epidermis is the outermost layer, and is very thin but highly cellular, measuring around 50-100 microns (i.e. 50/1000 of one mm), extending as far as the basement membrane (Figure XX). Underneath the epidermis and separated from it by the basement membrane is the dermis which comprises the remaining bulk of the skin thickness (~1.25mm). Skin cancer is almost entirely a disease of the outer 50-100 micron epidermis.

Epidermis

The epidermis sits on, and is separated from the dermis, by the acellular basement membrane. Most cells within the epidermis are either:

• Keratinocytes: Most (>90%) of the cells in the epidermis are keratinocytes, ectodermal derived cells, so named because they produce a range of proteins called keratins. Most common skin cancers are derived from keratinocytes
• Melanocytes: neural crest derived cells that produce melanin. Melanin protects against most types of skin cancer by reducing the harmful effects of sunshine. Malignancy of melanocytes is known as melanoma (or malignant melanoma). Most fatal skin cancers are melanomas.
• Langerhans’ cells: bone marrow derived antigen presenting cells. The immune system is important in skin carcinogenesis although the exact contribution Langerhans’ cells make to this process is not clear.

Epidermis: a stratified squamous epithelium

The epidermis is a stratified squamous epithelium. Stratified because it contains multiple layers and squamous reflecting that most of the cells are wider than they are tall. It comprises the following layers (moving from deep to superficial):

• Basal layer (aka stratum basale)
• Spindle cell layer (aka prickle cell layer or stratum spinosum)
• Granular cell layer (aka stratum granulosum)
• Stratum corneum (horny cell layer)

Basal cells are cuboidal keratinocytes that sit on the basement membrane that separates the epidermis from the dermis. The basal cell layer is only cell layer thick. Stem cells located in the basal layer undergo asymmetrical cell division, with one daughter cell being another stem cell, and the other a transient amplifying cell. Transient amplifying cells can undergo several rounds of division before they lose their ability to divide and differentiate into terminally differentiated keratinocytes. This stem cell pool is interfollicular, that is, it is located in the epidermis that lies between hair follicles.

There are two pools of keratinocyte stem cells in skin. The first has been discussed above (inter-follicular stem cell pool). There is believed to be a secondary stem cell pool situated in the hair follicle close to where the sebaceous glands join the follicle. These two pools are independent, but if the pool situated in the interfollicular skin is removed or damaged, stem cells from the hair follicle can repopulate the interfollicular stem cell pool.

The spindle cell layer is so named because of the spindle shape of the cells. It is also known as the prickle cell layer because the tight desmosomal attachments between cells tend to resemble spines, or prickles, under the microscope, after fixation (histopathological fixation shrinks tissues, so the cells pull away from each other, except where the desmosomes lie). This spindle cell layer forms the bulk of the thickness of the epidermis, and has multiple layers (>4).

The layer above the spindle cell layer is called the granular cell layer (stratum granulosum). This is the outermost viable layer of skin that contains keratinocytes with nuclei. In this layer, a variety of granules made up of a range of protein products (e.g.keratins, profilaggrin, loricrin) form, as well as lamellar lipids. These products replace the plasma membrane with what is termed the cornified envelope, a composite of these covalently cross-linked proteins. Outside the cornified envelope, is the the cornified lipid envelope.

The cells outermost to the granular cell layer, that have lost their nuclei and other cell organelles as a result of programmed cell death and have a cornified envelope, are known as corneocytes. These corneocytes make up the stratum corneum (horny cell layer). This is the outermost layer of skin, the layer you can see and feel, and is made up of a variable number of dead layers of keratinocytes. Although dead, the stratum corneum is not metabolically inert and, as we shall see, this layer plays an important role in the response of skin to sunshine (ultraviolet radiation).

The basement membrane and the dermis

Most skin cancers are derived from cells within the epidermis, and although the dermis makes up the physical bulk of skin, and may play important roles in carcinogenesis, you can get by without delving any further into its biology. Similarly, I have not discussed the formation of the epidermal appendages (sweat glands, sebaceous glands, or hair follicles). Again, these are not central to skin cancer, and where pertinent will be dealt with later in skincancer909. If you want read further, ed.derm.101 and the accompanying videos provide a more detail.

 

Questions on skin structure

[1] Name the four cell layers of the epidermis?

[2] What are the embryological origins of keratinocytes and melanocytes?

[3] What is the layer of anucleate cells called?

[4] What gives spindle cells their ‘prickles’?

[5] Where do you find keratinocyte stem cells?

[6] What is the cornified envelope?

[7] Which is thicker, the epidermis or the dermis?

[8] Which are most common: cancers derived from the epidermis or the dermis?

[9] Which layer within the epidermis is one cell thick?

[10] What compartment contributes most cells to skin: the epidermis or the dermis?

Answers

need to redo………..

1. Four layers of the epidermis are the basal cell layer, spindle cell layer, granular cell layer, and stratum corneum
2. The embryological origins of keratinocytes and melanocytes are ectoderm and neural crest respectively
3. The appendages — that is the pilosebaceous units (hair follicles and sebaceous glands) and eccrine sweat glands —are epidermal structures that have grown down into the dermis. They are made up of specialised keratinocytes. If the epidermis between the appendages is damaged they can repopulate the epidermis.
4. Desmosomes attach the spindle cells together if the cell shrinks (as in tissue processing for histology) the desmosomes appear as prickles
5. No, the last nucleated layer of the epidermis is the granular layer. Cells of the horny layer (stratum corneum) are dead and contain no nuclei.

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