Derm Dx: Large, pedunculated nodule in an obese patient - Clinical Advisor

Derm Dx: Large, pedunculated nodule in an obese patient

Slideshow

  • Slide

A moderately obese patient, aged 59 years, presented for evaluation of a bothersome lesion on his buttock that had been present for several years.

The patient complained that the growth occasionally rubbed on his undergarments and requested its removal. Family and personal history were negative for skin cancer.

On physical exam, a six centimeter flesh colored, pedunculated nodule was found on the right intertriginous groin.

The lesion was removed with scissor excision under local anesthesia.

This patient was diagnosed with a large acrochordon, otherwise known as a skin tag or fibroepithelial polyp. Skin tags occur in approximately 25% of males and females and are characterized by skin colored to hyperpigmented pedunculated lesions. They are most...

Submit your diagnosis to see full explanation.

This patient was diagnosed with a large acrochordon, otherwise known as a skin tag or fibroepithelial polyp. Skin tags occur in approximately 25% of males and females and are characterized by skin colored to hyperpigmented pedunculated lesions.

They are most frequently encountered in individuals with a larger body habitus. The most common locations are the axillae, followed by neck and inguinal regions. Friction is presumed to play a role in pathogenesis.1

Skin tags are usually attached to the skin by a narrow stalk. Although they are commonly one to two millimeters in diameter, acrocordons can reach significant size.2 Histologically, skins tags are characterized by a hyperplastic dermis with loosely arranged collagen fibers, along with dilated lymphatics and capillaries.3

Diagnosis is invariably made on clinical grounds with biopsy reserved for atypical appearing lesions. Removal by simple scissors excision or electrodessication is curative and performed for irritated lesions or cosmesis.

A study published in 1983 correlated the finding of multiple skin tags to colonic polyps and increased screening for gastrointestinal disease was advocated by some clinicians.4, 5 However, subsequent studies have disproved this link. 6, 7



Skin tags are more prevalent in patients with diabetes and insulin resistance and some studies suggest an association with increased risk of atherosclerosis and cardiovascular disease. 8, 9

Megha Patel, BS, is a medical student at the Commonwealth Medical College in Scranton, Pennsylvania.

Stephen Schleicher, MD, is an associate professor of Medicine at the Commonwealth Medical College and an Adjunct Assistant Professor of Dermatology at the University of Pennsylvania Medical College. He practices dermatology in Hazleton, Pennsylvania.

References

  1. Habif TP. (2010). Skin tags. (5th ed.). Clinical Dermatology (784). Philadelphia, PA: Elsevier.
  2. Lee JA, Khodaee M. (2012). Enlarging, pedunculated skin lesion. American Family Physician, 85(12):1191-1192
  3. Elder D. (1997). Tumors of fibrous tissue. (8th ed.). Lever’s Histopathology of Skin (872-874). Lippincott; New York, NY.
  4. Leavitt J, Klein I, Kendricks F, Gavaler J, Vanthiel DH. Ann of Intern. Med. 1983; 98(6):928-930.
  5. Beitler M, Eng A, Kilgour M, Lebwohl M. J Am Acad Dermatol. 1986; 14(6):1042-4.
  6. Gould BE, Ellison RC, Greene HL, Bernhard JD. Arch Intern Med. 1988; 148(8):1799-800.
  7. Akhtar AJ, Zhuo J. J Natl Med Assoc. 2003; 95(8):746-9.
  8. Sari R, Akman A, Alpsoy E, Balci MK. Clinical and Experimental Medicine. 2010; 10(3): 193-197.
  9. Shah R, Jindal A, Patel N. Ann Med Health Sci Res. 2014; 4(2):202-5.

Next hm-slideshow in Clinical Quiz