Skin tag (syn. achrochordon; fibroepithelial polyp)

A skin tag is a very common benign lesion composed of loose fibrous tissue and occurring mainly on the neck and major flexures as a small, soft pedunculated lesion.

This chapter is set out as follows: 

• Lesions are asymptomatic unless they catch on clothing or jewellery

Distribution

• Sides of the neck, axillae and groin. On the neck, skin tags are frequently associated with small seborrhoeic keratoses
• If extensive they can affect the face and trunk

Morphology

• Often multiple with an average size of 2 mm in diameter, but can be solitary and much larger
• Colour - often skin-coloured but can be hyperpigmented
• Pedunculated and may have a long stalk
• Soft and inelastic to palpate

Differential diagnosis

• The diagnosis is usually straightforward, however, a large tag can have a similar appearance to that of a pedunculated melanocytic naevus or a pedunculated neurofibroma

• Birt-Hogg-Dube syndrome - this is a rare autosomal dominant condition characterised by multiple skin tags along with many benign appendageal tumours, especially fibrofolliculomas, on the scalp, face, neck and upper trunk. Patients with this syndrome are at an increased risk of developing renal carcinoma as well as a spontaneous pneumothorax secondary to pulmonary cysts

Most lesions do not require treatment, for those that are problematic:

• Smaller lesions can be removed by way of snip excision or cryosurgery
• Those with a large base require local anaesthetic prior to being snipped
• For large numbers of tags the use of topical anaesthetic may be more appropriate