Acrochordon

Background

An acrochordon is a small, soft, common, benign, usually pedunculated neoplasm that is found particularly in persons who are obese. It is usually skin colored or hyperpigmented, and it may appear as surface nodules or papillomas on healthy skin. Most acrochordons vary in size from 2-5 mm in diameter, although larger acrochordons up to 5 cm in diameter are sometimes evident. The most frequent localizations are the neck and the axillae, but any skin fold, including the groin, may be affected.

Birt-Hogg-Dube (BHD) syndrome is a rare autosomal dominant genodermatosis characterized by skin tumors, including multiple fibrofolliculomas, trichodiscomas, and acrochordons.¹ These patients tend to develop renal and colonic carcinomas. The defective gene in BHD syndrome has been identified and is suspected of being a tumor suppressor gene. Several mutations of the BHD gene have been reported. All skin lesions in the syndrome may actually represent fibrofolliculomas cut in various planes of section.

Pathophysiology

Previous theories have suggested that a localized paucity of elastic tissue may result in sessile or atrophic lesions. It is also thought that pendulous variations may be caused by losses of large confluent areas of elastin; however, a recent study of elastic tissue in fibroepithelial polyps (FEPs) showed no significant abnormalities.

Frequency

International

Acrochordons have been reported to have an incidence of 46% in the general population.

Mortality/Morbidity

Acrochordons are benign tumors. On rare occasions, histologic examination of a clinically diagnosed FEP reveals a basal or squamous cell carcinoma. In a recent study, 5 of 1335 clinically diagnosed FEP specimens were malignant. Four were basal cell carcinomas, and one was a squamous cell carcinoma in situ. None of these specimens was submitted by a dermatologist. This study concluded that clinically diagnosed FEPs have a low probability of having malignant characteristics on histologic examination.

Sex

An equal prevalence of acrochordons exists in males and females.

Age

When present, acrochordons increase in frequency up through the fifth decade. As many as 59% of persons may have acrochordons by the time they are aged 70 years.

Treatment

Surgical Care

Skin tags are generally treated for noncosmetic reasons.

• Small, pedunculated acrochordons may be removed with curved or serrated blade scissors, while larger skin tags may simply require excision. For small acrochordons, application of aluminum chloride prior to removal will decrease the amount of minor bleeding.
• Anesthesia prior to electrodesiccation is another option.
• Other methods of removal include cryotherapy and ligation with a suture or a copper wire; however, freezing of the surrounding skin during liquid nitrogen cryotherapy may result in dyschromic lesions. Taking hold of the acrochordon with forceps and applying cryotherapy to the forceps may provide superior results.