Page 28 - The Netter Collection of Medical Illustrations - Integumentary System_ Volume 4 ( PDFDrive )

Plate 2-1 Integumentary System

ACROCHORDON

Acrochordons are better known by their common name
of skin tag or fibroepithelial polyp. They are found
universally throughout humankind. Probably every
adult has at least one skin tag located somewhere across
the surface of his or her skin. Except for a few loose
associations with certain syndromes, skin tags have no
clinical importance and are often ignored.
Clinical Findings: Skin tags can be found throughout
the adult population. They have no sex or race predilec- Common locations for skin tags
tion. They are completely benign skin growths that
have no malignant potential. They are most commonly
located in the axillae, on the neck, in the groin area, and Eyelids
on the eyelids but can be found in other locations. Skin Neck
tags are almost never seen in children. The finding of
a skin tag in a child should lead one to perform a biopsy Axilla
to rule out a basal cell carcinoma. Basal cell carcinoma
syndrome has been well documented to manifest in Inframammary
children, and the basal cell carcinoma has been shown
in this syndrome to mimic the appearance of skin tags.
If one sees a skin tag in a child, performs a skin biopsy, Fleshy small pedunculated papules Groin
and discovers it is a basal cell carcinoma, the patient
should immediately be evaluated for the basal cell car-
cinoma syndrome.
Most skin tags are minute, 1 to 5 mm in length, with
a skin-colored to slightly hyperpigmented appearance.
They are pedunculated papules that appear as out-
pouchings of the skin. They are soft and nontender.
Occasionally, larger skin tags are found with a thick-
ened or a more sessile stalk. These larger skin tags may
approach 1 to 1.5 cm in length with a 5-mm base. Most
individuals have more than one skin tag, and some indi-
viduals are afflicted with hundreds of them.
On occasion, a patient presents with a painful,
necrotic skin tag. This is most commonly caused by
trauma to the skin tag or twisting of the base that results
in strangulation of the blood supply and subsequent
necrosis. In these cases, removal is advised. If the
appearance or clinical history is not classic, the speci-
men should be sent for pathological evaluation.
Many investigations have looked at the association of
skin tags and underlying medical disorders with con-
flicting and confusing results. Patients with multiple
skin tags may be at a higher risk for glucose intolerance.
Some studies have even suggested that patients with
multiple skin tags are at a higher risk for colonic polyps,
but this is still subject to debate. Low power. The pedunculated skin tag is bisected High power. A slightly acanthotic epidermis is seen
Pathogenesis: The pathogenesis of skin tags is horizontally. It has a symmetrical appearance with overlying a vascular dermis with plentiful collagen.
believed to be a localized overgrowth of fibroblasts many small dermal capillaries present within a
within the dermis. They may be more common during background of collagen bundles.
pregnancy, and they have been shown to be increased
in patients with increased weight. This has led some
to implicate insulin-like growth factor-1 as a possible
driver of skin tag formation. The initiating factor is not Treatment: No therapy is necessary for these and skin tag removal scissors. Application of aluminum
completely understood. extraordinarily common skin growths. They are mostly chloride after removal causes the superficial bleeding
Histology: The overlying epidermis is essentially overlooked and not even mentioned on routine skin to stop.
normal. The skin tag appears as an outgrowth of the examination. The rare strangulated or thrombosed Screening of individuals with skin tags for errors
skin. The dermis appears normal, and there is a minimal skin tag can be removed easily with a forceps and skin in glucose metabolism or for colonic polyps is con-
inflammatory infiltrate present, if any at all. Throm- tag removal scissors after injection of a local anes- troversial but should be performed if other findings
bosed or strangulated skin tags show necrosis of the thetic. If cosmetic removal is desired, it can easily be in the review of systems or the clinical history and
dermis and epidermis and thrombosis of the superficial done by cleaning the skin with alcohol or chlorhexi- physical examination suggests one of these underlying
supplying blood vessels. There is no atypia present. dine and removing individual skin tags with a forceps disorders.

14 THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS