ACROCHORDON
Acrochordons are better
known by their common name of skin tag or fibroepithelial polyp. They are found
universally throughout humankind. Probably every adult has at least one skin
tag located somewhere across the surface of his or her skin. Except for a few
loose associations with certain syndromes, skin tags have no clinical
importance and are often ignored.
Clinical Findings: Skin tags can be found throughout the
adult population. They have no sex or race predilection. They are completely
benign skin growths that have no malignant potential. They are most commonly
located in the axillae, on the neck, in the groin area, and on the eyelids but
can be found in other locations. Skin tags are almost never seen in children.
The finding of a skin tag in a child should lead one to perform a biopsy to
rule out a basal cell carcinoma. Basal cell carcinoma syndrome has been well
documented to manifest in children, and the basal cell carcinoma has been shown
in this syndrome to mimic the appearance of skin tags. If one sees a skin tag
in a child, performs a skin biopsy, and discovers it is a basal cell carcinoma,
the patient should immediately be evaluated for the basal cell carcinoma
syndrome.
Most skin tags are minute, 1 to 5 mm in length, with a skin colored to
slightly hyperpigmented appearance. They are pedunculated papules that appear
as outpouchings of the skin. They are soft and nontender. Occasionally, larger
skin tags are found with a thickened or a more sessile stalk. These larger skin
tags may approach 1 to 1.5 cm in length with a 5-mm base. Most individuals have
more than one skin tag, and some individuals are afflicted with hundreds of
them.
On occasion, a patient presents with a painful, necrotic skin tag. This
is most commonly caused by trauma to the skin tag or twisting of the base that
results in strangulation of the blood supply and subsequent necrosis. In these
cases, removal is advised. If the appearance or clinical history is not
classic, the specimen should be sent for pathological evaluation.
Many investigations have looked at the association of skin tags and
underlying medical disorders with conflicting and confusing results. Patients
with multiple skin tags may be at a higher risk for glucose intolerance. Some
studies have even suggested that patients with multiple skin tags are at a
higher risk for colonic polyps, but this is still subject to debate.
Pathogenesis: The pathogenesis of skin tags is believed to
be a localized overgrowth of fibroblasts within the dermis. They may be more
common during pregnancy, and they have been shown to be increased in patients
with increased weight. This has led some to implicate insulin-like growth
factor-1 as a possible driver of skin tag formation. The initiating factor is
not completely understood.
Histology: The overlying epidermis is essentially normal.
The skin tag appears as an outgrowth of the skin. The dermis appears normal,
and there is a minimal inflammatory infiltrate present, if any at all. Thrombosed
or strangulated skin tags show necrosis of the dermis and epidermis and
thrombosis of the superficial supplying
blood vessels. There is no atypia present.
Treatment: No therapy is necessary for these extraordinarily
common skin growths. They are mostly overlooked and not even mentioned on
routine skin examination. The rare strangulated or thrombosed skin tag can be
removed easily with a forceps and skin tag removal scissors after injection of
a local anesthetic. If cosmetic removal is desired, it can easily be done by
cleaning the skin with alcohol or chlorhexidine and removing individual skin
tags with a forceps and skin tag
removal scissors. Application of aluminum chloride after removal causes the
superficial bleeding to stop.
Screening of individuals with skin tags for errors in glucose metabolism
or for colonic polyps is con- troversial but should be performed if other
findings in the review of systems or the clinical history and physical
examination suggests one of these underlying disorders.
