eMedicine Specialties > Dermatology > Benign Neoplasms

Acrochordon

Author: Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Coauthor(s): Agnieszka Terlikowska, MD, Staff Physician, Department of Dermatology, Medical University of Warsaw, Poland; Wanda M Patterson, MD, Department of Dermatology, UMDNJ-New Jersey Medical School
Contributor Information and Disclosures

Updated: Sep 2, 2009

Introduction

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

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

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.

Clinical

History

Acrochordons are flesh-colored pedunculated lesions that tend to occur in areas of skin folds.

  • A family history sometimes exists of acrochordons.
  • These tumors are usually asymptomatic, and they do not become painful unless inflamed or irritated.
  • Patients may complain of pruritus or discomfort when an acrochordon is snagged by jewelry or clothing.
  • Acrochordons may occur at unusual sites of the body. A huge acrochordon has been described on the penis.5 A lymphedematous acrochordon of the glans penis unassociated with condom catheter use also has been described.6 An acrochordon may be associated with vulval itching without the symptom being the result of fungal infection.7
  • Endoscopy may reveal FEPs arising in a ureter.8
  • Multiple skin tags are often linked with type 2  diabetes mellitus and with obesity, prompting a study of 58 people with skin tags. It showed that people with skin tags had significantly higher serum cholesterol and lower density lipoprotein levels, but not serum leptin levels, when compared with a healthy control group lacking skin tags.9

Physical

  • Skin tags may occur singly or multiply, and they are most often found in intertriginous areas (eg, axillae, neck, eyelids) (see Media File 1). They are also commonly located on the trunk, the groin, the abdomen, and the back.


A 53-year-old man with multiple, small, axillary ...

A 53-year-old man with multiple, small, axillary skin tags.

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A 53-year-old man with multiple, small, axillary ...

A 53-year-old man with multiple, small, axillary skin tags.

  • FEPs of the oral mucosa, anus, and vulvovaginal areas may be found.
  • These lesions may be flesh colored or hyperpigmented.
  • Three types of acrochordons are described.
    • Small, furrowed papules of approximately 1-2 mm in width and height, located mostly on the neck and the axillae
    • Single or multiple filiform lesions of approximately 2 mm in width and 5 mm in length occurring elsewhere on the body
    • Large, pedunculated tumor or nevoid, baglike, soft fibromas that occur on the lower part of the trunk
  • Pedunculated lesions may become twisted, infarcted, and fall off spontaneously.

Causes

  • Frequent irritation seems to be an important causative factor, especially in persons who are obese. An opinion also exists that acrochordons are simply the effect of skin aging, with many factors responsible for their development.
    • Hormone imbalances may facilitate the development of acrochordons (eg, high levels of estrogen and progesterone during pregnancy, high levels of growth hormone in acromegaly).
    • Epidermal growth factor (EGF) and alpha tissue growth factor (TGF) have also been implicated in the development of tumors such as these.
    • Whether any infective factors initiate acrochordon growth is still not clear.
  • Human papillomavirus (HPV) types 6/11 DNA were found in a high percentage of skin tag biopsy samples obtained from 49 white patients (see Human Papillomavirus). According to the authors of the study, viral infection should be considered as a pathogenic cofactor.10
  • Acrochordons associated with fibrofolliculomas and trichodiscomas have been described as components of BHD syndrome, an autosomal dominant disorder. They have been reported to accompany other neoplasms, especially tumors of the gastrointestinal tract and kidneys.
    • Neoplasms are suggested to produce and release growth factors that cause acrochordon growth into the circulation.
    • The results of a recent study refute the theory that an association of acrochordons and colonic polyps actually exists.
  • An association with type 2 diabetes mellitus has been observed.11,12
    • A study of 118 research subjects with acrochordon reported an incidence of 40.6% of either overt type 2 diabetes mellitus or impaired glucose tolerance.
    • Reports exist suggesting that the mechanism is through the effect of insulin and glucose starvation.13
    • The previous study showed no correlation between the location, size, color, or number of acrochordons with impairment of glucose tolerance.

More on Acrochordon

Overview: Acrochordon
Differential Diagnoses & Workup: Acrochordon
Treatment & Medication: Acrochordon
Follow-up: Acrochordon
Multimedia: Acrochordon
References
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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. 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].

  6. 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].

  7. 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].

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

  9. 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.

  10. 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].

  11. 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].

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

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

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

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

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

  17. 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].

  18. 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].

  19. 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].

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

  21. 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].

  22. 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].

  23. 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].

  24. 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].

  25. 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].

  26. Agarwal JK, Nigam PK. Acrochordon: a cutaneous sign of carbohydrate intolerance. Australas J Dermatol. Dec 1987;28(3):132-3. [Medline].

  27. Brodell RT, Pokorney DR. Fibroepithelial polyps and pathologic evaluation. Arch Dermatol. Jul 1997;133(7):915-6. [Medline].

  28. De la Torre C, Ocampo C, Doval IG, Losada A, Cruces MJ. Acrochordons are not a component of the Birt-Hogg-Dubé syndrome: does this syndrome exist? Case reports and review of the literature. Am J Dermatopathol. Aug 1999;21(4):369-74. [Medline].

  29. From L, Assad D. Neoplasms, pseudoneoplasms and hyperplasias of the Dermis - Acrochordon. In: Freedberg IM, ed. Fitzpatrick's Dermatology in General Medicine. Vol 1. 5th ed. New York, NY: McGraw-Hill; 1166-7.

  30. Menn JJ, Boberg J. Fibroepithelial polyps. An unusual case report. J Am Podiatr Med Assoc. Sep 1990;80(9):496-8. [Medline].

  31. Potter TS, Sharata HH, Su WP, Hashimoto K. Pedunculated proliferative papillomatosis. Cutis. Jun 1996;57(6):451-2. [Medline].

  32. Rathbun ED. A method for removing the acrochordon (skin tag). Kans Med. Jan 1990;91(1):11-2. [Medline].

  33. Rodriguez-Serna M, Martinez A, Perez A, Medina E, Aliaga A. Eruptive skin tags and keratoacanthomas in a patient with prolactinoma and colonic polyposis. Dermatology. 1994;189(2):215-6. [Medline].

  34. Varma JR. Skin tags--a marker for colon polyps?. J Am Board Fam Pract. Jul-Sep 1990;3(3):175-80. [Medline].

  35. Worm M, Skarabis W, Audring H, Sterry W, Kolde G. Nevoid bag-like soft fibromas. Dermatology. 1999;199(2):167-8. [Medline].

  36. Zuber TJ. The price tag for skin tags. Hosp Pract (Minneap). Mar 15 1997;32(3):221-2. [Medline].

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Further Reading

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Keywords

acrochordon, skin tags, soft fibromas, fibroepithelial polyps, FEP, fibroma pendulans, pedunculated fibromas, soft warts

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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, UMDNJ-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.

Medical Editor

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.

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
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.

Managing Editor

Jeffrey J Miller, MD, Associate Professor of Dermatology, Penn State University College of Medicine; Staff Dermatologist, Penn 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.

CME Editor

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 None; Genentech Consulting fee Consulting; Centocor Consulting fee Consulting; Centocor Grant/research funds None; Covance Consulting fee Consulting; Shire  Consulting

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

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