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Skin tags are small, often pedunculated, skin-coloured or brown papules that occur most frequently where there are skin folds. Common sites are the neck, axilla, groins and eyelids. They are also known as acrochordons. They are usually 0.2 to 0.5 cm in diameter.

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Skin tags are very common and may occur in up to half of the population. They occur in both men and women and incidence increases with age. They are more common in patients with type 2 diabetes and those with obesity.

Aetiology

It may be that skin tags are caused by irritation and chaffing as skin folds rub together. They may be more common at sites where rubbing of clothing over skin occurs.

Diagnosis

Diagnosis is usually apparent from the typical appearance. Skin tags are usually pedunculated and have been described as looking as though they hang from the skin. They may also be sessile.

Differential diagnosis

• Filiform warts have fine finger-like projections on the surface and tend to be firmer on palpation. Melanocytic naevi can also be pedunculated but have a broader base.
• Multiple skin tags are seen in Birt-Hogg-Dubé (BHD) syndrome; a rare, autosomal dominant inherited dermatosis characterised by multiple skin lesions developing in adulthood, mainly on the face, neck and upper body. As well as skin tags, those affected have fibrofolliculomas and trichodiscomas, benign skin tumours forming around hair follicles.
• Benign Skin Tumours

Primary care management

Skin tags do not have malignant potential but are often removed due to irritation or for cosmetic reasons. Small skin tags may be removed by snipping off with a pair of sharp scissors or by applying a ligature round the base. If the base is fine no anaesthetic is needed and little bleeding occurs. Cryotherapy is sometimes also used.

Larger ones will need local anaesthetic and can be removed by shave and cautery, or cutting cautery alone.