Giant skin tags: Report of two cases

Susana Canalizo-Almeida 1 , Patricia Mercadillo-Pérez 2 , Andrés Tirado-Sánchez 1

Dermatology Online Journal 13 (3): 30



1. Service of Dermatology, Hospital General de México. andrestiradosanchez@hotmail.com2. Service of Dermatopathology, Hospital General de México.

Abstract

Skin tags are skin-colored, pedunculated tumors with a smooth surface. Histologically are composed by loose collagen fibers and dilated capillaries. Giant skin tags are reported rarely in the literature. We present the case of two giant skin tags on labium majus. To our knowledge, these are the largest skin tags reported.

Skin tags are skin-colored, asymptomatic, pedunculated lesions located at the neck, axillae or groin. It affects any age, including infants and can be frequently seen alone, but in some cases, can be associated with colonic polips (Gardner syndrome), diabetes, or obesity [1].

Skin tags are generally diagnosed by clinical features. However, histopathological examination may be needed for diagnosis in unusual cases [2].

We present a patient with two giant skin tags on the labium majus.

Clinical synopsis

Figure 1 Figure 2 Figure 1. A long, pedunculated tumor on the labium majus measuring 30cm in size.

Figure 2. A solitary, bag-like, pedunculated mass on the labium majus measuring 15cm in diameter.

Case 1. A 19-year-old female presented with a lesion on the labium majus of 2 years duration. The lesion was asymptomatic, skin-colored, pedunculated, and measured 30 cm in diameter (Fig. 1). The lesion was treated with complete excision and primary closure under local anesthesia.

Case 2. A 56-year-old female presented a flesh-colored, soft, pedunculated, asymptomatic lesion, measuring 15 cm in diameter (Fig. 2). The patient had noted the gradually enlarging tumor for 4 years. Total excision of the lesion was performed under local anesthesia with primary closure.

Histopathologic examination was performed; papillomatosis, regular acanthosis, loose collagen fibers, and numerous dilated capillaries were noted.

Discussion

There are a few case reports of giant skin tags including one reported on the labium majus [3]. Theories about the causes include genetic predisposition, metabolic diseases, hyperinsulinemia, and even virus infection (papillomavirus) [4].

The lesions are slow growing. On histologic examination, loose connective tissue and vascularisation are found. Differential diagnosis include seborrheic keratosis, warts, lipoma, cysts, and neurofibroma [2].

If long-standing, skin tags can become fibrous, vascularised, or ischemic. However, none of these changes were observed in our patients.

References

1. Gould BE, Ellison RC, Greene HL, Bernhard JD. Lack of association between skin tags and colon polyps in a primary care setting. Arch Intern Med 1988; 148: 1799-800. PubMed 2. Banik R, Lubach D. Skin tags: localization and frequencies according to sex and age. Dermatologica 1987; 174: 180-3. PubMed 3. Doe PT, Grattan CE. Guess what! Skin tag (acrochordon) on the labium majus. Eur J Dermatol 1998; 8: 587. PubMed 4. Dianzani C, Calvieri S, Pierangeli A, Imperi M, Bucci M, Degener AM. The detection of human papillomavirus DNA in skin tags. Br J Dermatol 1998; 138: 649-51. PubMed

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