What is the best way to minimize scarring in the removal of skin tags? I find that cryotherapy results in too much hyperpigmentation.
—STEPHANIE PADILLA, MN, RNC, ARNP, Seattle
Skin tags, also referred to as acrochordons or fibroepithelial polyps, are pedunculated papules that extend from the body. Because cryotherapy with liquid nitrogen usually results in a blister between the epidermis and the dermis, it is a good treatment modality for the management of lesions restricted to the epidermis (e.g., actinic keratoses and warts). A skin tag includes both epidermis and dermis. Cryotherapy in this situation may result in necrosis of the lesion with subsequent postinflammatory hyperpigmentation of the lesional site. In contrast, conservative snip excision of the lesion (either with or without prior local anesthesia, depending on the diameter of the lesion) will result in a small oval scar that can heal by second intention following achievement of hemostasis with a topical agent, such as 20% aluminum chloride in alcohol.
—Philip R. Cohen, MD (124-11)