Pedro Almodovar’s new movie “The Skin I Live In,” which opens Friday in South Florida, looks at first glance to be pure Almodovar, suggesting the boundary-pushing enfant terrible who emerged in Spanish cinema in the 1980s. We see a recurrence of a number of Almodovar tropes – kink, bondage, sex, sadism and violence. But these B-movie elements are exploited in a fundamentally different setting than the subversive comedies on which he stoked his career. “The Skin I Live In,” with its mystifying medical implications, ugly rapes and near-rapes and shifting emotional allegiances, doesn’t have much time for humor, charting a path toward grim neo-noir bleackness before ending on an coda that is indescribably moving. This is Almodovar employing the cinematic language of his anarchic past to make one his most mature, precisely controlled adult entertainments.

It stars Antonio Banderas as Robert Ledgard, a plastic surgeon working on the groundbreaking – if professionally illegal – innovation of a genetically altered skin that will be resistant to burns, cuts and other abrasions. Haunted by his wife’s horrifying death following a car crash years earlier, Robert is out to change medicine, or at least satiate his own perverse obsession to reverse his personal history. He has a human subject named Vera (Elena Anaya) who doesn’t appear to be a willing participant. A guinea pig in a flesh-colored body suit, she is a prisoner in a symmetrical room in his manse, with two TV channels and yoga equipment to amuse herself. A bizarre home invasion by a criminal in a tiger costume, loosed from the Carnival in Cadiz, triggers a look at Robert’s back story, which unfolds, unpredictably, like a thrilling novel.

Banderas’ Robert is most certainly a mad doctor – albeit one with matinee-idol looks – and at first it feels like Almodovar is out to homage the crazy-scientist movies – like “The Brain That Wouldn’t Die” – that flourished in the ‘50s. For a while, it is this sort of a film, but by the time we become engrossed in its extended central flashback, “The Skin I Live In “has undergone the first of its many reassignment surgeries, if you will – dramaturgical operations that alter the film’s moral compass, which, by the end, has gone fairly haywire. Shocking reversals and fluctuations in our sympathies characterize the strange proceedings, making for a thrilling experience. With so much formulaic garbage cluttering the multiplexes, there is bliss in seeing a film like this, where I genuinely had no idea what shot, scene, or line of dialogue would follow the previous one. So what if its substance is only skin-deep?

“The Skin I Live In” opens Friday at Cinemark Palace and Regal Shadowood in Boca Raton, Regal Delray Beach 18, Regal Boynton Beach 18, the Gateway Theatre in Fort Lauderdale and the Coral Gables Art Cinema, among many theaters.