Skin Tags

These benign skin lesions are extremely common. They are sometimes referred to as acrochordons, fibroepithelial polyps, or, if large, soft fibromas or pedunculated lipofibromas. They are commonly seen in the body folds of many adults as well as obese individuals.
Skin tags were formerly suspected by several investigators to be markers for intestinal polyps or, possibly, internal malignant diseases, but current evidence suggests that this association is not justifiable.

Clinical Manifestations ⬆ ⬇

Skin tags are generally 1- to 10-mm fleshy papules.
They may be skin-toned, tan, or darker than the patient's skin. They are sessile or pedunculated in shape.
Skin tags are primarily of cosmetic concern; however, they may become a nuisance from the irritation of necklaces and underarm shaving, for example.
In women, they tend to grow larger and more numerous over the course of a pregnancy.
They are often seen in association with acanthosis nigricans (see Chapter 23: Pigmentary Disorders).

Diagnosis ⬆ ⬇

Differential Diagnosis

Small Pedunculated SKs (see Fig. 30.14)

Compound or Dermal Nevus (see earlier in this chapter)

Neurofibroma

Management

Small skin tags are easily removed by snipping them off at their base using iris scissors, with or without prior local anesthesia (see Chapter 35: Diagnostic and Therapeutic Techniques). The crushing action of the scissors results in little bleeding or pain.
Skin tags, if disregarded, occasionally may spontaneously self-destruct. After torsion, they become necrotic and autoamputate.

Helpful Hint

A rapid and painless treatment for small skin tags is to dip a needle holder or nontoothed forceps into liquid nitrogen for 5 to 10 seconds and then gently grasp each skin tag for about 5 to 10 seconds. There is little or no collateral damage, just a narrow rim of erythema. Multiple lesions can be treated using this method. The frozen skin tag will be shed in approximately 10 days. This is a good approach for skin tags hanging on the eyelids (Figs. 30.21A,B and 30.22).