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.