Acrochordon

Updated: Jun 02, 2017
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Overview

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

Interestingly, skin tags have been used for reconstruction of the ear and of the nose, particularly for distal nasal reconstruction. [4]

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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. [5]

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. [6]

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. [7]

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Epidemiology

Frequency

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

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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Prognosis

Acrochordons are benign tumors. On rare occasions, histologic examination of a clinically diagnosed FEP reveals a basal or squamous cell carcinoma. In one 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.

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Patient Education

Advise patients that these are benign tumors.

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