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A 59-year-old man with obesity requests the removal of a growth on his right thigh. He states that the lesion has been present for nearly a decade and is frequently irritated by clothing but has not bled. His medical history is significant for hypertension and type 2 diabetes. The physical examination reveals a 6-cm flesh-colored nodule. Scattered skin tags and seborrheic keratoses are noted elsewhere on the body.
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The lesion proved to be a large acrochordon, otherwise known as a fibroepithelial polyp, soft fibroma, papilloma, or simply, a skin tag.1 Acrochordons are typically flesh-colored to brown in coloration and range in size from 1 mm to several centimeters; many are pedunculated.
Lesions are often encountered on the eyelids, neck, axilla, and groin, and occur most commonly in individuals with obesity. Traumatic events such as chronic rubbing of clothes may play a role in causation.2 Chronic conditions that are associated with acrochordons include diabetes and metabolic syndrome.3 Skin tags may also arise or increase in number during pregnancy.4
Acrocordons can cause discomfort especially when they arise in areas of friction or proximity to jewelry. Patients may deem the lesions as cosmetically unacceptable. Several treatment modalities are available including snip excision, electrodesiccation, cryosurgery, and, for larger lesions, shave excision.5
Lawrence Schiffman, DO, is the founder and director of Miami Skin Dr, in Doral, Florida. Stephen Schleicher, MD, is director of the DermDox Dermatology Centers, associate professor of medicine at Geisinger Commonwealth Medical College, and clinical instructor of dermatology at Arcadia University and Kings College.
References
1. Oakley A. Skin tag. DermNet. 2004. Accessed August 15, 2023. https://dermnetnz.org/topics/skin-tag
2. El Safoury OS, Fawzy MM, Hay RM, Hassan AS, El Maadawi ZM, Rashed LA. The possible role of trauma in skin tags through the release of mast cell mediators. Indian J Dermatol. 2011;56(6):641-646. doi:10.4103/0019-5154.91819
3. Akpinar F, Dervis E. Association between acrochordons and the components of metabolic syndrome. Eur J Dermatol. 2012;22(1):106-110. doi:10.1684/ejd.2011.1572
4. Wong RC, Ellis CN. Physiologic skin changes in pregnancy. J Am Acad Dermatol. 1984;10(6):929-940. doi:10.1016/s0190-9622(84)80305-9
5. Belgam Syed SY, Lipoff JB, Chatterjee K. Acrochordon. In: StatPearls [Internet]. StatPearls Publishing; August 8, 2022. Accessed August 15, 2023.
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