THE SKIN CENTER

2/20/10

• What is a skin tag?
• Where do skin tags occur?

• Who tends to get skin tags?

• Will removing a skin tag cause more to grow?

• Is a skin tag a tumor?
• Are skin tags contagious?

• What does a skin tag look like under a microscope?

• What problems do skin tags cause?

• How are skin tags treated?

• Does medical insurance cover skin tag removal?

• Do any creams remove skin tags?

• Should I worry about cutting my skin tag by shaving?

• Do skin tags need to be sent for biopsy?

• Are there vaginal skin tags?

• Can you get skin tags on the penis and scrotum?

• What happens when a skin tag suddenly turns purple or black?

• What else could it be?

• Is there another medical name for a skin tag?

• Skin Tag At A Glance

What is a skin tag?

Skin tags are common, acquired benign skin growths that look like a small piece of soft, hanging skin. The medical name for skin tag is acrochordon. Skin tags are harmless growths and more than half of adults may have at least one of these growths at some time in their life. The general population has an incidence of skin tags of 46%. Some small tags spontaneously rub or fall off painlessly and the person may not even know they had a skin tag. Most tags do not fall off on their own and stay around once formed. Some individuals may be more prone to tags (greater than 50-100 tags) either through increased weight, part combined with heredity, or other unknown causes. Males and females are equally prone to developing skin tags. Obesity and being moderately overweight (even temporary increases) dramatically increase the chances of having skin tags. Normal weight individuals with larger breasts are also more prone to skin tags under their breasts. Skin tag pictures demonstrate bits of skin or flesh-colored tissue that project from the surrounding skin from a small, narrow stalk. Some people call these growths “skin tabs” or barnacles. Skin tags typically occur in characteristic locations including the neck base, underarms, eyelids, groin folds, and under the breasts (especially where underwire bras rub directly beneath the breasts). Although skin tags may vary somewhat in appearance, they are usually smooth or slightly wrinkled and irregular, flesh-colored or slightly more brown, and hang from the skin by a small stalk. Early or beginning skin tags may be as small as a flattened pinhead-sized bump around the neck. While most tags typically are small (2-5mm in diameter) at approximately one third to one half the size of a pinky fingernail, some skin tags may become as large as a big grape(1 cm in diameter) or a fig (5 cm in diameter).

Where do skin tags occur?

Skin tags can occur almost anywhere on the body where there is skin. However, the top 2 favorite areas for skin tags are the neck and armpits. Other areas include the eyelids, upper chest (particularly under the female breasts), buttock folds, and groin folds. Tags are typically thought to occur in characteristic friction locations where skin rubs against skin or clothing.  More plump or chunkier babies may also develop skin tags in areas where skin rubs against skin like the sides of the neck. Younger children may develop tags at the upper eyelid areas- often in areas where they may rub. Older children and pre-teens may develop tags in the underarm (axilla) area from friction and repetitive irritation from sports.

Who tends to get skin tags?

More than half if not all of the general population is reported to have skin tags at some time in their life. Although tags are generally acquired (not present at birth) and may occur in anyone, more often they arise in adulthood. They are much more common in middle age and they tend to increase in prevalence up to age 60. Children and toddlers may also develop skin tags in these underarm and neck areas. Since skin tags are thought to arise more readily in areas of skin friction or rubbing, tags are also more common in overweight people.

Hormone elevations, such as those seen during pregnancy, may cause an increase in the formation of skin tags, as skin tags are more frequent in pregnant women. Tags are essentially harmless and do not have to be treated unless they are bothersome. Symptomatic skin tags may be easily removed during or after pregnancy, typically by a dermatologist.

Skin tags are a benign condition and not directly associated with any other major medical conditions. Skin tags are commonly found on healthy people and do not have to be removed.

Will removing a skin tag cause more to grow?

There is no evidence that removing a skin tag will causes more tags to grow. There is no expectation of causing skin tags to “seed” or spread by removing them. In reality, some people are simply more prone to developing skin tags and may have new growths periodically. Some individuals require periodic removal of tags at annual or even quarterly intervals with their dermatologist or physician.

Is a skin tag a tumor?

Skin tags are a type of harmless skin growth or tumor, albeit a completely benign one. Tags are generally not cancerous (malignant) and don’t become cancerous if left untreated.   

There are extremely rare instances where a skin tag may become pre-cancerous or cancerous. Skin tag-like bumps that bleed, grow, or display multiple colors like pink, brown, red, and black, may need to be biopsied to exclude other causes like skin cancer.

Are skin tags contagious?

No. There is not strong evidence to suggest that common skin tags are contagious. Most likely, people do not catch them from anyone and do not transmit it to anyone. 

While warts are caused by a virus called HPV and are known to be very contagious, most skin tags are not thought to be caused by HPV. A small study showed that some skin tags may have a viral association.

What does a skin tag look like under a microscope?

Skin tag microscopic pictures look like a small hanging pearl. Laboratory preparation of the tissue is required before looking at the skin tag under the microscope. The skin is stained with a stain called hematoxylin and eosin “H&E”. Under the microscope, there is a two colored round ball and typically a small stalk. The purple outer layer (epidermis) overlies a pink core (dermis).

The outer layer of the skin (the epidermis) shows overgrowth (hyperplasia), and it encloses an underlying layer of skin (the dermis) in which the normally-present collagen fibers appear abnormally loose and swollen. Usually there are no hairs, moles, or other skin structures present in skin tags.

While the majority of skin tags when removed are by standard discarded in special medical waste containers for proper handling, sometimes tissue may be sent to the lab for microscopic exam by a specialized doctor called a pathologist. Irregular skin growths that are larger, bleed, or have an unusual presentation may require laboratory microscopic examination to make sure there are no irregular cells or skin cancers.

Some common skin tag look a-likes include seborrheic keratosis, moles, warts, cysts, milia, neurofibromas, and nevus lipomatosus.  On extremely rare occasions, skin cancers like basal cell carcinoma, squamous cell carcinoma, and malignant melanoma may mimic skin tags. 

·         Seborrheic keratosis

·         Moles

·         Warts

·         Cysts

·         Neurofibromas

·         Nevus lipomatosus 

What problems do skin tags cause?

Skin tags are generally fairly harmless and quite friendly. Except for the cosmetic appearance, they essentially cause no physical pain or discomfort. These tiny skin growths generally cause symptoms when they are repeatedly irritated as, for example, by the collar or in the groin. Cosmetic removal for unsightly appearance is perhaps the most common reason they are removed. Occasionally, a tag may require removal because it has become irritated and red from bleeding (hemorrhage) or black from twisting and dying of the skin tissue (necrosis). Sometimes they may become snagged by clothing, jewelry, pets, or seatbelts, causing pain or discomfort. Overall these are very benign growths that have no cancer (malignant) potential.

Occasionally a tag may spontaneously fall off without any pain or discomfort. This may occur after the tag has twisted on itself at the stalk base, interrupting the blood flow to the tag.

How are skin tags treated?

It is important to keep in mind that skin tags usually do not have to be treated. Deciding to have no treatment is always a reasonable option if the growths are not bothersome at all. If the tags are bothersome, multiple home and medical options are available.

·         Tie off tag at narrow base with a piece of dental floss or string

·         Freeze with liquid nitrogen

·         Burn using electric cautery or hyfrecator

·         Scissor removal with or without anesthetic

There are several effective medical ways to remove a skin tag, including removing with scissors, freezing (using liquid nitrogen), and burning (using medical electric cautery at the physician's office).

Usually small tags may be removed easily without anesthesia while larger growths may require some local anesthesia (injected lidocaine) prior to removal. Application of a topical anesthesia cream prior to the procedure may be desirable in areas where there are a large number of tags.

·         Lidocaine injection

·         Betacaine cream

·         LMX 5% cream

Dermatologists (skin doctors), family physicians, and internal medicine physicians are the doctors who treat tags most often. Occasionally, an eye specialist (ophthalmologist) is needed to remove tags very close to the eyelid margin.

·         Dermatologist

·         Family physician

·         Internal medicine physician

·         Ophthalmologist

There are also home remedies and self-treatments, including tying off the small tag stalk with a piece of thread or dental floss and allowing the tag to fall off over several days.

The advantage of scissor removal is that the growth is immediately removed and there are instant results. The potential disadvantage of any kind of scissor or minor surgical procedure to remove tags is minor bleeding.

Possible risks with freezing or burning include temporary skin discoloration, need for repeat treatment(s), and failure for the tag to fall off.

There is no evidence that removing tags causes more tags to grow. Rather, there are some people that may be more prone to developing skin tags and may have new growths periodically. Some patients even require periodic removal of tags at annual or quarterly intervals.

Does medical insurance cover skin tag removal?

Many if not all insurance carriers classify skin tags as cosmetic and therefore a self-pay treatment. Most people may expect to pay out of pocket for skin tag removal and request an estimate from their medical provider for the number of tags they want to remove in one session. In uncommon instances, documented medical necessity of suspicious growths or highly symptomatic growths may support medical treatment of skin tags.

Do any creams remove skin tags?

There are no currently medically approved creams for the removal of skin tags. Skin tags are removed usually by physical methods like cutting off or tying off with dental floss. It is not advisable to use unapproved products like dermisil, wart removers, essential oils, nail polish, toothpaste, or hair removal creams like Neat or Nair. Trial uses of unapproved creams may cause irritation and possible secondary complications.

Should I worry about cutting my skin tag by shaving?

No. Skin tags are frequently and inadvertently shaved off while removing hair from the axilla either with a razor or by waxing. There is typically no harm done when small skin tags are removed by shaving.

Sometimes even a small skin tag base may bleed for a while and require constant applied pressure for 10-15 minutes to stop bleeding. Skin infection is a rare possible complication of accidentally shaving off skin tags.

Do skin tags need to be sent for biopsy?

Most typical small skin tags may be removed without sending tissue for microscopic examination or biopsy. Removed skin tags are typically discarded by medical facilities in special medical waste containers designed for proper handling. 

However, there are some larger or atypical growths that may be removed and sent to a pathologist for examination under a microscope to make sure that the tissue is really a skin tag and nothing more. Additionally, skin bumps that have bled or rapidly changed may also need pathologic examination.

Some common skin tag look a-likes include friendly barnacles called seborrheic keratosis, common moles, warts, neurofibroma, and a fatty mole called nevus lipomatosus.  While extremely rare, there are a few reports of skin cancers found in skin tags. Skin cancers like basal cell carcinoma, squamous cell carcinoma, and malignant melanoma may rarely mimic skin tags. 

What else could it be?

While classic skin tags are typically very characteristic in appearance and occur in specific locations such as the underarms, necks, under breasts, eyelids and groin folds, there are tags that may occur in less obvious locations.

Other skin growths that may look similar to a skin tag but are not tags include moles (dermal nevus), nerve and fiber-type moles (neurofibromas), warts, and "barnacles" or "Rice Krispies" (seborrheic keratosis).

• Moles

• Neurifibromas

• Warts

• Seborrheic keratosis

Warts tend to be rougher, with a "warty" irregular surface whereas skin tags are usually smooth. Warts tend to be flat whereas tags are more like bumps hanging from thin stalk. While warts are almost entirely caused by human papilloma virus (HPV), tags are only sometimes associated with HPV.

Groin and genital lesions resembling skin tags may actually be genital warts or condyloma. A biopsy would help diagnose which of these growths are not skin tags. Very rarely, a basal cell skin or squamous cancer or melanoma may mimic a skin tag, but this is very uncommon.

Are there vaginal skin tags?

While typical skin tags are not usually seen in the vagina or in other moist, mucosal surfaces there are other types of benign polyps that occur in these areas. Irritation polyps or soft fibromas may occur on vaginal areas, mouth, and anal skin. Skin tags most commonly occur on dry skin like neck, armpits and groin folds. Viral caused growths like genital warts and condyloma needs to be considered in the possible diagnosis for growths in genital areas.

Skin tags may infrequently occur at the external genitalia like the labia majora and labia minora.  These growths may be caused by normal friction from underwear, panty liners or feminine sanitary products, sexual activity, or masturbation, Again, sexually transmitted viral conditions like genital warts may need to be ruled out by tissue biopsy of growths in this area.

Can you get skin tags on the penis and scrotum?

Skin tags may occur at unusual sites like the penis, scrotum and opening of the penis tip. Tags are associated with friction at the location where they occur.  Friction or repeat irritation from condom use, underwear, sexual activity, masturbation, and urinary catheters may cause skin tags on the penis and scrotum. Sexually transmitted viral conditions like genital warts may need to be ruled out by tissue biopsy of growths in the genital area.

What happens when a skin tag suddenly turns purple or black?

A thrombosed or clotted skin tag may suddenly change colors and become purple or black. Thrombosed skin tags are usually painless and are more concerning to the person because of the color. Thrombosed skin tags typically may fall off on their own in 3-10 days and don’t require additional treatment.

Skin tags that have changed color or bleed may require your doctor’s evaluation and reassurance. Rarely, thrombosed skin tags may be a sign of another condition and need to be biopsied.

Is there another medical name for a skin tag?

Medical terms your physician or dermatologist may use to describe a skin tag include fibroepithelial polyp, acrochordon, cutaneous papilloma, and soft fibroma. All of these terms describe skin tags and are benign (noncancerous), painless skin growths. Some people refer to these as "skin tabs" or warts. However, a skin tag is best known as a skin tag.

·         Fibroepithelial polyp

·         Acrochordon

·         Cutaneous papilloma

·         Soft fibroma

Skin Tag at a Glance

• Skin tags are very common but harmless small, soft skin growths.

• Skin tags occur on the eyelids, neck, armpits, groin folds, and under breasts.

• One person may have anywhere from just 1 to over 100 skin tags.

• Almost anyone may develop a skin tag at some point in their life.

• Middle aged, obese adults are most prone to skin tags.

• Obesity is a major risk factor for developing skin tags.

• Removing a skin tag does not cause more to grow.

• Some people are just more prone to forming skin tags. Treatments include freezing, tying off with a thread or suture, or cutting off.