Definition and Overview

A skin tag, medically known as an acrochordon or a fibroepithelial polyp, is a benign tumour, usually small and composed of a fibrotic core covered by skin. These masses typically develop in areas where the skin folds and creases are found, such as the armpit and the neck. Skin tags are usually raised off from the skin, attached via a fleshy stalk known as a peduncle. They are painless masses, and they generally do not grow to significant sizes (typically less than 1 cm).

Skin tags are found in approximately 45% of individuals and are more commonly seen in females than in males. The risk of developing them increases as one gets older. They are believed to develop from the rubbing of skin on skin. Some studies have shown certain kinds of human papillomavirus (HPV), specifically HPV 6 and HPV 11, can be found in skin tags, and may have a role in its formation. Meanwhile, other studies have shown an association of these lesions with insulin resistance and obesity. Thus, some sources have suggested that skin tags may indicate a higher risk for cardiovascular diseases and atherosclerosis. Genetics is also believed to contribute to their development.

Who Should Undergo and Expected Results

A skin tag is a benign lesion. No treatment is necessary unless it:

  • Becomes irritated or infected, which is usually caused by repeated contact with clothes or jewellery

  • Interferes with normal functioning. For instance, skin tags on the eyelids may produce eye pain and vision disturbances.

  • Causes sufficient discomfort to the patient, such as in the case of large skin tags on the thighs that may make it difficult for the patient to walk.

  • Is linked to squamous cell carcinoma or a basal cell carcinoma - There have been reports of skin tags examined histologically revealing a squamous cell carcinoma or a basal cell carcinoma; however, these are rare instances.


The most frequent indication for skin tag removal is for cosmetic purposes. A skin tag may be removed if the patient prefers to have the procedure done.

How is the Procedure Performed?

Skin tag removal is an office procedure that is usually performed by a dermatologist. For skin tags found in sensitive locations, a specialist may have to perform the removal. For example, a skin tag found on the eyelid may be better removed by an ophthalmologist while a skin tag located in the perianal area is best excised by a surgeon.

There are several techniques for removing a skin tag. These include cauterisation, cryosurgery, ligation, and excision.

Electrocauterisation, which is a treatment option for small skin tags, makes use of high-frequency current that produces heat energy in order to burn the cells of the lesion. Topical anaesthetic is applied to the skin tag, and after several minutes, a heated device known as a cautery probe or pen is made to touch the lesion. The skin tag is burned off and the burnt material is removed. An antibiotic ointment is usually applied to the cauterised area, and patients are advised not to wash the area overnight.

At the other end of the spectrum is cryosurgery, which utilises a special substance, usually liquid nitrogen, to freeze the skin tag. During the procedure, the basement membrane is disrupted, resulting in tissue destruction. The application of the substance on the skin tag may be done using a cotton applicator or a cryoprobe. Some physicians use forceps to grasp the skin tag and apply cryotherapy to the forceps to minimise damage to surrounding normal tissues. The skin tag eventually falls off on its own. This procedure is also ideal for small skin tags.

Both cauterisation and cryosurgery are ablative procedures, which means that tissue is destroyed and cannot be sent for examination.

Other options for the removal of small skin tags include simply cutting the skin tag off using curved scissors, and ligation of the stalk using suture material or a copper wire to cut off the blood supply to the lesion.

Large skin tags, on the other hand, may require excision for complete removal. This requires a minor surgical procedure performed under local anaesthesia. If the stalk is narrow, it can be shaved off with a scalpel and cauterised for hemostasis. The skin reepithelialises after a few days. On the other hand, if the stalk is wide, a fish mouth incision may be done around the stalk, up to the dermis. A small amount of normal skin may be removed together with the skin tag. The remaining skin is then sutured together.

Possible Risks and Complications

There are very few risks associated with skin tag removal, and complications are minor. Bleeding and infection rarely occur while pain and soreness are minimal, especially if the skin tags are small. Pain can usually be managed with over-the-counter pain medications. Redness and swelling can likewise occur but typically resolves on their own.

The usual complication of skin tag removal is related to scar formation. Cryotherapy of skin tags may result in discoloration of the skin but is usually temporary. Small scars may also be left after skin tag removal. For most people, wound healing is unremarkable, and the scar is barely visible. However, if the patient is prone to developing hypertrophic scars or keloids, the scar may become dystrophic, resulting in poor cosmetic outcomes. Unpleasant scars may be managed via several ways, including the application of special creams, steroid injections, and surgical revision.

Fibroepithelial polyps are not known to recur; however, some patients who are prone to developing skin tags can develop new lesions, which may require repeat treatments.

References:

  • Savage JA, Maize JC Sr. Keratoacanthoma clinical behavior: a systematic review. Am J Dermatopathol. 2014 May. 36(5):422-9

  • Papp DF, Khanna AJ, McCarthy EF, Carrino JA, Farber AJ, Frassica FJ. Magnetic resonance imaging of soft-tissue tumors: determinate and indeterminate lesions. J Bone Joint Surg Am. 2007 Oct. 89 Suppl 3:103-15.

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