This is one of the most common benign skin tumors, commonly known as skin tags and occasionally fibroepithelial polyps. These lesions are benign but may be associated with other disease states, occasionally warranting closer examination of the patient for other signs and symptoms.
Epidemiology Disease Associations Pathogenesis Laboratory/Radiologic/Other Diagnostic Testing Gross Appearance and Clinical Variants Histopathological Features and Variants Special Stains/
Differential Diagnosis Prognosis Treatment Commonly Used Terms Internet Links
EPIDEMIOLOGY CHARACTERIZATION SYNONYMS INCIDENCE/PREVALENCE AGE SEX GEOGRAPHY EPIDEMIOLOGIC ASSOCIATIONS
DISEASE ASSOCIATIONS CHARACTERIZATION ACANTHOSIS NIGRICANS BIRT-HOGG-DUBE SYNDROME Acrochordons are not a component of the Birt-Hogg-Dube syndrome: does this syndrome exist? Case reports and review of the literature.
De la Torre C, Ocampo C, Doval IG, Losada A, Cruces MJ.
Service of Dermatology, Hospital Provincial, Pontevedra, Spain.
Am J Dermatopathol. 1999 Aug;21(4):369-74. Abstract quote
Multiple fibrofolliculomas, trichodiscomas, and acrochordons compose the triad of cutaneous lesions characterizing the Birt-Hogg-Dube syndrome, inherited in an autosomal dominant fashion.
We report a case of a family who had the triad of tumors of the Birt-Hogg-Dube syndrome. Two members were observed clinically and histologically. Biopsies of the facial papules disclosed features of the fibrofolliculoma/trichodiscoma spectrum. Lesions that were clinically acrochordon-like proved to correspond to the same histopathologic spectrum. The characterization of the nature of the acrochordon-like lesions in our patients and the review of the literature allow us to question if acrochordons (skin tags) should be maintained as a component of this association.
In light of our conclusion that fibrofolliculoma, trichodiscoma, and the acrochordon-like lesions are histologic variations of a single lesion, we further question whether the term "syndrome" is valid.
DIABETES MELLITUS Acrochordon and impaired carbohydrate metabolism.
Demir S, Demir Y.
Department of Internal Medicine, Faculty of Medicine, Afyon Kocatepe University, Turkey.
Acta Diabetol. 2002 Jun;39(2):57-9. Abstract quote
Acrochordons were reported to have a probable association with diabetes mellitus but detailed data about this relation has not been introduced yet.
We evaluated 120 patients with acrochordon for the presence of impaired carbohydrate metabolism. Overt diabetes mellitus (DM) was found in 88 patients and glucose intolerance was detected in 6 patients; 4 patients had reactive hypoglycemia.
We concluded that acrochordons may be skin markers of underlying impaired carbohydrate metabolism and the patients with acrochordon should be evaluated for the presence of diabetes mellitus.
NEVOID BASAL CELL SYNDROME
Acrochordons as a presenting sign of nevoid basal cell carcinoma syndrome.
Chiritescu E, Maloney ME.
Division of Dermatology, The Pennsylvania State University, College of Medicine, The Milton S. Hershey Medical Center, USA.
J Am Acad Dermatol. 2001 May;44(5):789-94. Abstract quote
BACKGROUND: Nevoid basal cell carcinoma syndrome (NBCCS) is a genodermatosis with autosomal dominant inheritance. In identified kindreds the diagnosis is relatively easy, but for the patients without family history of this syndrome a high clinical suspicion is necessary for diagnosis.
OBJECTIVE: Acrochordons are distinctly uncommon in childhood. Our purpose was to evaluate skin tags that develop at an early age.
METHODS: This is a retrospective series evaluation of 7 children who presented with pedunculated papules (acrochordon-like growths). A full history was then correlated with biopsy results in each patient.
RESULTS: Clinically, lesions consisted of flesh-colored and pigmented pedunculated papules. Histopathologic examination of these papules showed basal cell carcinomas in each biopsy specimen.
CONCLUSION: We consider that "skin tag"-like basal cell carcinomas in childhood may represent a marker for NBCCS. Early diagnosis of this syndrome and early sun protection of the affected children could help decrease the number of lifetime tumors. Biopsy should be performed on acrochordons in children because they may be the presenting sign of NBCCS. Because these tags may precede other stigmata of the NBCCS, recognition may facilitate early diagnosis and allow early treatment and sun protection.
PATHOGENESIS CHARACTERIZATION HAMARTIN AND TUBERIN
Hamartin and tuberin immunohistochemical expression in cutaneous fibroepithelial polyps.
Wu J, Khalil FK, Keehn CA, Saeed S, Morgan MB.
Department of Pathology, University of South Florida College of Medicine, Tampa, FL, USA.
J Cutan Pathol. 2004 May;31(5):383-7. Abstract quote
Background: Hamartin and tuberin are inactivating tumor suppressor proteins implicated in the development of gastrointestinal polyps and sporadic and tuberous sclerosis-associated cutaneous angiofibromas. The pattern of expression of these peptides has not been studied in fibroepithelial polyps (FEPs).
Design: The specific aim of the study was to evaluate the immunohistochemical expression of tuberin and hamartin within the epithelium and dermal fibrocytes of 20 cutaneous FEPs compared with the epithelium and dermal fibrocytes of normal skin. The diagnoses were confirmed independently by a dermatopathologist, and the pattern of intensity was assessed by the mean labeling intensity (MLI) of cytoplasmic and/or nuclear staining for each antibody.
Results: Hamartin and tuberin antibodies showed moderate staining of the keratinocytes and fibrocytes of normal skin and the keratinocytes within FEPs. Both antibodies showed diminished staining within the fibrocytes of the FEPs. The MLI of hamartin was 44.3 +/- 4.4 for keratinocyte nuclei in normal skin and 51.2 +/- 3.7 within the polyps. The MLI of tuberin was 42.9 +/- 3.6 within the keratinocyte nuclei of the normal skin compared to 39.7 +/- 3.0 for the polyps. The MLI for hamartin within the fibrocytes of the normal skin was 78.9 +/- 7.1 compared to 21.6 +/- 4.2 within the polyps, p = 0.01. The MLI for tuberin within the fibrocytes of normal skin was 70.6 +/- 5.0 compared to 47.1 +/- 4.7 within the polyps.
Conclusion: The data suggest that down regulation or loss of tuberin and/or hamartin expression may be permissive to fibrocyte proliferation or promote collagen production leading to FEP formation.
CHARACTERIZATION RADIOLOGIC LABORATORY MARKERS
CHARACTERIZATION GENERAL VARIANTS PENIS
- A huge unusual mass on the penile skin: acrochordon.
Emir L, Ak H, Karabulut A, Ozer E, Erol D.
Clinics of Urology, Ankara Teaching and Research Hospital, Ministry of Health, Ankara, Turkey.
Int Urol Nephrol. 2004;36(4):563-5. Abstract quote
Acrochordons are flesh-coloured pedunculated lesions which occur in areas of skin folds.
Although they are common in other sites of the body, we report the first case of huge penile acrochordon in the literature.
Clinical, pathological and surgical findings of this lesion were presented and discussed.
HISTOLOGICAL TYPES CHARACTERIZATION GENERAL Polypoid segment of skin with a fibrovascular core VARIANTS PAGETOID DYSKERATOSIS
- Am J Dermatopathol. 2006 Dec;28(6):478-81 Abstract quote
BACKGROUND:: Pagetoid dyskeratosis (PD) is considered a casual finding. We can find it in some conditions, including acrochordons and soft fibromas.
OBJECTIVE:: (1) to compare the presence of PD in soft fibromas and acrochordons and (2) to compare PD positive fibromas and PD negative fibromas.
MATERIALS AND METHODS:: We reviewed all acrochordons and soft fibromas diagnosed in the General Hospital of Lanzarote, Spain, between January 2001 and December 2002. We assessed the presence of PD, size, acanthosis, basal pigmentation, and the presence of pseudohorn cysts.
RESULTS:: Three hundred sixty one acrochordons and 164 soft fibromas were included in this study. There were striking differences in the presence of PD, size, acanthosis, and basal pigmentation between both entities. PD positive fibromas predominated in axillas. There were no other differences between PD positive fibromas and PD negative fibromas.
CONCLUSION:: Although soft fibromas and acrochordons are actually fibroepithelial polyps, including the presence of PD, there are striking differences between them. Thus, both conditions have to be considered as different entities. PD could be related to friction and moisture. PD has to be distinguished from other conditions such as Paget's disease, pagetoid melanoma, koilocytes, clear cell papulosis, among others.
CUTANEOUS PSEUDOSARCOMATOUS POLYP
- Cutaneous pseudosarcomatous polyp: a recently described lesion.
Division of Surgical Pathology and Cytopathology, University of Virginia Medical Center, PO Box 800214, Charlottesville, VA 22908, USA.
- Ann Diagn Pathol. 2008 Dec;12(6):440-4. Abstract quote|
Three cases of cutaneous pseudosarcomatous polyp, a lesion recently described in the dermatopathology literature, are reported here. These benign proliferations display dramatic cytologic pleomorphism, but despite their disquieting morphological features, they have behaved in a benign fashion to date. All 3 lesions in this study were clinically innocuous, with 1 having been present for 1 year and another for 2 years.
The first lesion arose on the back of a 30-year-old man, the second on the nasal columella of a 65-year-old woman, and the third on the back of a 91-year-old woman. All 3 had the typical architecture of a fibroepithelial polyp (acrochordon) with widely separated stellate cells occupying a myxoid to collagenous stroma. Markedly pleomorphic stellate cells were widely dispersed, with an increased density of atypical cells beneath the epidermis and in small foci of adipose tissue in 1 case. Multinucleated cells, some with a floret-type configuration, were also observed. One of the polyps demonstrated focal mild hyalinization of vessel walls. Only rare mitotic figures were identified in 2 cases, but 1 showed atypical forms. Immunohistochemically, the atypical cells reacted diffusely for vimentin and variably for CD34 and factor XIIIa, but they lacked smooth muscle actin and desmin.
Cutaneous pseudosarcomatous polyps can be added to the list of pathologic entities with symplastic or pseudomalignant features.
- Cutaneous pseudosarcomatous polyp: a histological and immunohistochemical study.
Department of Dermatology and Pathology, University of California, Irvine, USA.
- J Cutan Pathol. 1996 Apr;23(2):189-93. Abstract quote
Two unusual acquired polypoid skin lesions exhibited prominent histological atypia, but were biologically benign. Both patients were elderly females. The lesions clinically mimicked fibroepithelial polyp or nevus lipomatosus. Both had been present for about 20 years. One lesion was located on the back, the other on the posterior thigh. Each lesion exhibited dilated, hyalinized vessels in the dermis with focal fibrin deposits, myxoid stroma, and a population of bizarre, pleomorphic spindle to stellate cells, some of which were multinucleated. Occasional atypical mitoses were present. One lesion had abundant admixed fat. Immunohistochemical staining was strongly positive only for vimentin.
The lesions share features with degenerating angiofibroma and vaginal pseudosarcomatous polyp. As in these lesions, the atypia is most probably reactive and degenerative.
CHARACTERIZATION SPECIAL STAINS IMMUNOPEROXIDASE ELECTRON MICROSCOPY
DIFFERENTIAL DIAGNOSIS KEY DIFFERENTIATING FEATURES
TREATMENT CHARACTERIZATION GENERAL Simple removal
Macpherson and Pincus. Clinical Diagnosis and Management by Laboratory Methods. Twentyfirst Edition. WB Saunders. 2006.
Rosai J. Ackerman's Surgical Pathology. Ninth Edition. Mosby 2004.
Sternberg S. Diagnostic Surgical Pathology. Fourth Edition. Lipincott Williams and Wilkins 2004.
Robbins Pathologic Basis of Disease. Seventh Edition. WB Saunders 2005.
DeMay RM. The Art and Science of Cytopathology. Volume 1 and 2. ASCP Press. 1996.
Weedon D. Weedon's Skin Pathology Second Edition. Churchill Livingstone. 2002
Fitzpatrick's Dermatology in General Medicine. 6th Edition. McGraw-Hill. 2003.
Weiss SW and Goldblum JR. Enzinger and Weiss's Soft Tissue Tumors. Fifth Edition. Mosby Elesevier 2008
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