Acrochordon 

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Mar 9, 2012
 

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.[2] 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.[3] All skin lesions in the syndrome may actually represent fibrofolliculomas cut in various planes of section.

Related Medscape Reference articles of possible interest include Premalignant Fibroepithelial Tumor (Pinkus Tumor), Benign Vulvar Lesions, and Skin, Benign Skin Lesions.

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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 1999 study of elastic tissue in fibroepithelial polyps (FEPs) showed no significant abnormalities.[4]

A cross-sectional study of adult patients at a university teaching hospital, including 98 patients and 103 controls, found that the presence of multiple skin tags was strongly associated with insulin resistance, irrespective of other risk factors.[5]

In another survey, 113 patients with skin tags and 31 healthy subjects were evaluated. This work linked obesity, dyslipidemia, hypertension, insulin resistance, and elevated high-sensitive C-reactive protein with skin tags, suggesting they may serve as a marker of increased risk of atherosclerosis and cardiovascular disease.[6]

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Epidemiology

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.

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Contributor Information and Disclosures
Author

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi

Disclosure: Nothing to disclose.

Coauthor(s)

Agnieszka Terlikowska, MD  Staff Physician, Department of Dermatology, Medical University of Warsaw, Poland

Disclosure: Nothing to disclose.

Wanda M Patterson, MD  Department of Dermatology, UMDNJ-New Jersey Medical School

Wanda M Patterson, MD is a member of the following medical societies: Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

Evan R Farmer, MD  Clinical Professor of Pathology and Dermatology, Department of Pathology, Virginia Commonwealth University School of Medicine

Evan R Farmer, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, American Medical Association, American Society of Dermatopathology, and International Society of Dermatology

Disclosure: Nothing to disclose.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Jeffrey J Miller, MD  Associate Professor of Dermatology, Pennsylvania State University College of Medicine; Staff Dermatologist, Pennsylvania State Milton S Hershey Medical Center

Jeffrey J Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Professors of Dermatology, North American Hair Research Society, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Joel M Gelfand, MD, MSCE  Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania

Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

  1. Kawasaki H, Sawamura D, Nakazawa H, Hattori N, Goto M, Sato-Matsumura KC, et al. Detection of 1733insC mutations in an Asian family with Birt-Hogg-Dube syndrome. Br J Dermatol. Jan 2005;152(1):142-5. [Medline].

  2. Toro JR, Glenn G, Duray P, et al. Birt-Hogg-Dube syndrome: a novel marker of kidney neoplasia. Arch Dermatol. Oct 1999;135(10):1195-202. [Medline].

  3. Haimowitz JE, Halpern AC, Heymann WR. Multiple, hereditary dome-shaped papules and acrochordons. Birt-Hogg-Dube syndrome. Arch Dermatol. Sep 1997;133(9):1163, 1166. [Medline].

  4. Adams BB, Mutasim DF. Elastic tissue in fibroepithelial polyps. Am J Dermatopathol. Oct 1999;21(5):446-8. [Medline].

  5. Tamega Ade A, Aranha AM, Guiotoku MM, Miot LD, Miot HA. [Association between skin tags and insulin resistance]. An Bras Dermatol. Feb 2010;85(1):25-31. [Medline].

  6. Sari R, Akman A, Alpsoy E, Balci MK. The metabolic profile in patients with skin tags. Clin Exp Med. Dec 24 2009;[Medline].

  7. Emir L, Ak H, Karabulut A, Ozer E, Erol D. A huge unusual mass on the penile skin: acrochordon. Int Urol Nephrol. 2004;36(4):563-5. [Medline].

  8. Peña KB, Parada DD. Lymphedematous fibroepithelial polyp of the glans penis non-associated with condom catheter use. APMIS. Mar 2008;116(3):215-8. [Medline].

  9. Singh N, Thappa DM, Jaisankar TJ, Habeebullah S. Pattern of non-venereal dermatoses of female external genitalia in South India. Dermatol Online J. Jan 15 2008;14(1):1. [Medline].

  10. Carey RI, Bird VG. Endoscopic management of 10 separate fibroepithelial polyps arising in a single ureter. Urology. Feb 2006;67(2):413-5. [Medline].

  11. Gorpelioglu C, Erdal E, Ardicoglu Y, Adam B, Sarifakioglu E. Serum leptin, atherogenic lipids and glucose levels in patients with skin tags. Indian J Dermatol. 2009;54:20-22.

  12. Boza JC, Trindade EN, Peruzzo J, Sachett L, Rech L, Cestari TF. Skin manifestations of obesity: a comparative study. J Eur Acad Dermatol Venereol. Sep 20 2011;[Medline].

  13. Akp?nar F, Derv?s E. Association between acrochordons and the components of metabolic syndrome. Eur J Dermatol. Nov 7 2011;[Medline].

  14. Senel E, Salmanoglu M, Solmazgül E, Berçik Inal B. Acrochordons as a cutaneous sign of impaired carbohydrate metabolism, hyperlipidemia, liver enzyme abnormalities and hypertension: a case-control study. J Eur Acad Dermatol Venereol. Dec 21 2011;[Medline].

  15. Dianzani C, Calvieri S, Pierangeli A, Imperi M, Bucci M, Degener AM. The detection of human papillomavirus DNA in skin tags. Br J Dermatol. Apr 1998;138(4):649-51. [Medline].

  16. Levine N. Brown patches, skin tags on axilla. Are this patient's velvety plaques related to his obesity and diabetes?. Geriatrics. Oct 1996;51(10):27. [Medline].

  17. Thappa DM. Skin tags as markers of diabetes mellitus: an epidemiological study in India. J Dermatol. Oct 1995;22(10):729-31. [Medline].

  18. Goyal A, Raina S, Kaushal SS, Mahajan V, Sharma NL. Pattern of cutaneous manifestations in diabetes mellitus. Indian J Dermatol. 2010;55(1):39-41. [Medline]. [Full Text].

  19. Mathur SK, Bhargava P. Insulin resistance and skin tags. Dermatology. 1997;195(2):184. [Medline].

  20. Cathro HP, Patterson JW, Wick MR. Cutaneous pseudosarcomatous polyp: a recently described lesion. Ann Diagn Pathol. Dec 2008;12(6):440-4. [Medline].

  21. Baldo A, De Natale F, Parisi A, Lo Presti M. Un singolare fibroma pendulo. Chronica Dermatologica (Roma). 1995;5:719-23.

  22. Granados S, Cohen L. Metastatic melanoma presenting as an infarcted acrochordon. J Cutan Pathol. 2003;30:61.

  23. Schwartz RA, Tarlow MM, Lambert WC. Keratoacanthoma-like squamous cell carcinoma within the fibroepithelial polyp. Dermatol Surg. Feb 2004;30(2 Pt 2):349-50. [Medline].

  24. Chiritescu E, Maloney ME. Acrochordons as a presenting sign of nevoid basal cell carcinoma syndrome. J Am Acad Dermatol. May 2001;44(5):789-94. [Medline].

  25. Feito-Rodriguez M, Sendagorta-Cudos E, Moratinos-Martinez M, Gonzalez-Beato MJ, de Lucas-Laguna R, Pizarro A. Dermatoscopic characteristics of acrochordon-like basal cell carcinomas in Gorlin-Goltz syndrome. J Am Acad Dermatol. Feb 21 2009;[Medline].

  26. Agir H, Sen C, Cek D. Squamous cell carcinoma arising from a fibroepithelial polyp. Ann Plast Surg. Dec 2005;55(6):687-8. [Medline].

  27. Paredes BE, Mentzel T. Atypical Lipomatous Tumor/"Well-Differentiated Liposarcoma" of the Skin Clinically Presenting as a Skin Tag: Clinicopathologic, Immunohistochemical, and Molecular Analysis of 2 Cases. Am J Dermatopathol. Feb 24 2011;[Medline].

  28. Bord A, Valsky DV, Yagel S. Prenatal sonographic diagnosis of congenital perineal skin tag: case report and review of the literature. Prenat Diagn. Nov 2006;26(11):1065-7. [Medline].

  29. Eads TJ, Chuang TY, Fabre VC, Farmer ER, Hood AF. The utility of submitting fibroepithelial polyps for histological examination. Arch Dermatol. Dec 1996;132(12):1459-62. [Medline].

  30. Monfrecola G, Riccio G, Viola L, Procaccini EM. A simple cryo-technique for the treatment of cutaneous soft fibromas. J Dermatol Surg Oncol. Feb 1994;20(2):151-2. [Medline].

  31. Wang LT, Wu CC, Hsiao CW, Feng CC, Jao SW. A modified ferguson hemorrhoidectomy for circumferential prolapsed hemorrhoids with skin tags. Dis Colon Rectum. Apr 2008;51(4):456-61. [Medline].

  32. Eley KA, Pleat JM, Wall SA. Reconstruction of a congenital nasal deformity using skin tags as a chondrocutaneous composite graft. J Craniofac Surg. Mar 2009;20(2):573-5. [Medline].

 
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A 53-year-old man with multiple, small, axillary skin tags.
A hyperplastic epidermis showing papillomatosis, hyperkeratosis, and acanthosis overlying loosely arranged collagen fibers and many capillaries.
A higher-power view demonstrating to better advantage loosely arranged collagen fibers and many capillaries.
 
 
 
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