Derm Dx: A growth on the armpit - Clinical Advisor

Derm Dx: A growth on the armpit

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The patient is a 42-year-old man requesting removal of a growth located on his right armpit. He is moderately obese and gives no history of systemic disease. The lesion is occasionally irritated during physical activity. Examination reveals a hyperpigmented protuberance.

Skin tags, also called acrochordons, occur in approximately 25% of males and females and are characterized by skin colored to hyperpigmented pedunculated lesions. They are most frequently encountered in overweight individuals. The most common locations are the axilla, followed by...

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Skin tags, also called acrochordons, occur in approximately 25% of males and females and are characterized by skin colored to hyperpigmented pedunculated lesions. They are most frequently encountered in overweight individuals. The most common locations are the axilla, followed by the neck and inguinal regions, and friction is presumed to play a role in pathogenesis.1

Skin tags are usually attached to the skin by a narrow stalk. Although commonly 1 to 2 mm in diameter, acrochordons 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,4 and increased screening for gastrointestinal disease was advocated by some clinicians.5 However, subsequent studies disproved this link.6 Skin tags are more prevalent in individuals with diabetes and insulin resistance, and some studies suggest an association with increased risk of atherosclerosis and cardiovascular disease.7

Dr Schleicher is director of the DermDox Center for Dermatology, as well as an associate professor of medicine at the Commonwealth Medical College and a clinical instructor of dermatology at Arcadia University and Kings College.

References

  1. Habif TP. Skin tags (acrochordon) and polyps. Clinical Dermatology. 5th ed. New York: Elsevier; 2010:784.
  2. Alkhalili E, Prapasiri S, Russell J. Giant acrochordon of the axilla. BMJ Case Rep. 2015 Jul 3;2015.
  3. Elder D. Tumors of fibrous tissue. Lever’s Histopathology of Skin. 8th ed. Philadelphia: Lipponcott; 1997:872-874.
  4. Leavitt J, Klein I, Kendricks F, Gavaler J, Vanthiel DH. Skin tags: A cutaneous marker for colonic polyps. Ann Intern Med. 1983;98:928-930.
  5. Beitler MEng AKilgour MLebwohl M. Association between acrochordons and colonic polyps. J Am Acad Dermatol. 1986;14:1042-1044.
  6. Akhtar AJZhuo J. Non-association between acrochordons and colonic polyps in a minority population. J Natl Med 
  7. Shah RJindal APatel N. Acrochordons as a cutaneous sign of metabolic syndrome: a case-control study. Ann Med Health Sci Res. 2014;4:202-205.

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