Hyperplasia
Skin Tag
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Skin Tag
, Acrochordon, Fibroepithelial Stromal Polyp, Fibroepithelial Polyp
Definitions
Skin Tag (Acrochordon, Fibroepithelial Stromal Polyp)
Benign epidermal hyperplastic lesion (Skin Tag)
Epidemiology
Very common (occurs in 25% of adults)
Increasing
Prevalence
with age (esp. over age 50 years)
Risk factors
Obesity
Advancing age
Pregnancy
Metabolic Syndrome
Pathophysiology
Develops in regions of increased skin friction and irritation
Lesion of mesenchymal origin
Hormone
Sensitive
Signs
Characteristics
Usually pedunculated (narrow stalk) but may be sessile
Flesh-color to brown
Typically 2-5 mm in size (may be up to 1 cm, up to 20 cm in rare cases)
May ulcerate or erode, bleed or have discharge with irritation
Distribution
Axilla
Neck
Inguinal area
Vulva
Differential Diagnosis
Pedunculated intradermal nevus
Seborrheic Keratosis
Neurofibroma
Nevoid
Basal Cell Carcinoma
syndrome
Skin Tags seen in childhood
Only indication to send Skin Tags for histology
Chiritescu (2001) J Am Acad Dermatol 44:789-94 [PubMed]
Lab
Pathology is indicated in only atypical lesions
Send one specimen per jar
Management
Indications for excision
Local irritation
Cosmesis
Biopsy if present in childhood (see above)
Techniques for destruction
Refer those with
Eyelid
involvement
Local Anesthesia
only required for larger lesions
Cut quickly in one stroke if not using
Local Anesthesia
Pedunculated Skin Tags
Excise with iris scissors
Apply topical
Aluminum Chloride
(e.g.
Drysol
) for coagulation
Electrodesiccation
Electrocautery at lesion base
Preferred over cautery in darker skinned patients
Cryotherapy
(for small Skin Tags)
Exercise
caution in patients with darker skin
Consider using an ear speculum to focus
Cryotherapy
on lesion
Sessile Skin Tags
Shave excision
References
Tavelli in Noble (2001) Primary Care, Mosby, p. 771
Higgins (2015) Am Fam Physician 92(7): 601-7 [PubMed]
Luba (2003) Am Fam Physician 67(4):729-738 [PubMed]
Oluyadi (2023) Am Fam Physician 107(1): 87-8 [PubMed]
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