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Patient Case: Fibroepithelial Polyps (Skin Tags)

Patient Case: Fibroepithelial Polyps (Skin Tags)

Discussion

A 54-year-old woman visits her primary care physician due to multiple small, soft, skin-colored growths on her neck and underarms. She first noticed them a few years ago, and they have gradually increased in number. The lesions are painless, but she finds them annoying, especially when they get caught in her necklaces or clothing.

On examination, the lesions are pedunculated, flesh-colored, and range from 2 to 5 mm in size. They are soft and mobile, with no signs of ulceration, bleeding, or inflammation. The patient has a history of type 2 diabetes mellitus and is slightly overweight.

A clinical diagnosis of fibroepithelial polyps (skin tags) is made. The patient is reassured that these are benign and common, especially in individuals with diabetes or obesity. She is offered simple removal methods like snip excision, cryotherapy, or electrocautery for cosmetic reasons or if they become irritated.

Questions
  1. What is the most likely diagnosis for this patient’s skin lesions?
    a) Seborrheic keratosis
    b) Fibroepithelial polyps (skin tags)
    c) Verruca vulgaris (common warts)
    d) Actinic keratosis
  2. Which of the following factors is most commonly associated with an increased risk of skin tags?
    a) Type 2 diabetes mellitus and obesity
    b) Chronic sun exposure
    c) Autoimmune diseases
    d) Vitamin D deficiency
  3. What is the best management approach for skin tags?
    a) Wide surgical excision with histopathological analysis
    b) Topical corticosteroids
    c) Reassurance, with removal if symptomatic or for cosmetic reasons
    d) Systemic antibiotics
  4. Which of the following describes the typical appearance of fibroepithelial polyps (skin tags)?
    a) Scaly, rough, and hyperpigmented plaques
    b) Flat, erythematous patches with central clearing
    c) Soft, pedunculated, flesh-colored growths
    d) Painful, ulcerating nodules with rolled borders
Reveal answers

Answers

  1. (b) Fibroepithelial polyps (skin tags)
    • The small, pedunculated, flesh-colored growths in skin folds are classic for skin tags, differentiating them from seborrheic keratosis, warts, or actinic keratosis.
  2. (a) Type 2 diabetes mellitus and obesity
    • Skin tags are commonly associated with metabolic disorders, including diabetes, obesity, and insulin resistance, rather than chronic sun exposure or autoimmune diseases.
  3. (c) Reassurance, with removal if symptomatic or for cosmetic reasons
    • Skin tags are benign and typically do not require treatment unless they become irritated or the patient desires removal for cosmetic reasons using cryotherapy, excision, or electrocautery.
  4. (c) Soft, pedunculated, flesh-colored growths
    • Skin tags are soft, mobile, and pedunculated. They do not ulcerate or become scaly like actinic keratoses or seborrheic keratoses, making this option the correct choice.