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You really just need Bodyshop and an image editing program to make CAS-related items. Skins generally don't require EPs, so having just the SC shoudn't be a problem as long as you've got Bodyshop. Not sure if SC comes with bodyshop, or if you'd have to download it separately, but it should be available.
How photo-realistiic you want it would depend. Would perhaps start with a skin that isn't too far from what you have in color/skin type, and use good quality pictures.
"Photoskinned" (aka using photos directly) items have a tendency to not look particularly good, depending on skill with the image editing program + photo bases, just so you're warned. The more shadows/highlights on the pictures, the worse it's going to look - you'll want to aim for "flat" pictures, so the game can handle lighting.