A skin is not an image, it's a mapping from a skin placeholder name (eg head
) to the actual attachment to use for the skin placeholder (eg head-red
). The attachment is what has a reference to an image to draw.
It sounds like what you want to do is create a region attachment that uses the PNG you specify. That is possible, but it may be easier for you to use BoneFollower. That makes a Unity GameObject follow a Spine bone, so then you can easily show an image or anything else on top of or behind your skeleton. If you need to draw something within your skeleton, then you'd need to create a region attachment.
Do you have a Spine atlas for your image? If so, you can look at ToRegionAttachment
:
https://github.com/EsotericSoftware/spine-runtimes/blob/4.1/spine-unity/Assets/Spine/Runtime/spine-unity/Utility/AttachmentRegionExtensions.cs#L71
If you have an individual image instead of an atlas, one of my colleagues can give some advice. They've called it a day in their timezone, but they'll be here tomorrow.