What is a skin tag?

A skin tag is a common, acquired benign skin growth that looks like a small piece of hanging skin. Skin tags are often described as bits of skin- or flesh-colored tissue that projects from the surrounding skin from a small, narrow stalk. They typically occur in characteristic locations including the neck, underarms, eyelids, and under the breasts (especially where underwire bras rub directly beneath the breasts). Although skin tags may vary somewhat in appearance, they are usually smooth or slightly wrinkled and irregular, flesh-colored or slightly more brown, and hang from the skin by a small stalk. Early or beginning skin tags may be as small as a flattened pinpoint-sized bump around the neck. Some skin tags may be as large as a big grape.

Where do skin tags occur?

Skin tags can occur almost anywhere there is skin. However, favorite areas for tags are the eyelids, neck, armpits, upper chest (particularly under the female breasts), and groin folds. Tags are typically thought to occur in characteristic locations where skin rubs against skin or clothing.

Who tends to get skin tags?

Nearly half of the population is reported to have skin tags at some time. Although tags are generally acquired (not present at birth) and may occur in anyone, more often they arise in adulthood. They are much more common in middle age and they tend to increase in prevalence up to age 60. Children and toddlers may also develop skin tags in the underarm and neck areas. Since they are thought to arise more readily in areas of skin friction or rubbing, tags are also more common in overweight people.

Picture of skin tags

Hormone elevations, such as those seen during pregnancy, may cause an increase in the formation of skin tags, as skin tags are more frequent in pregnant women. Tags may be easily removed during or after pregnancy.

Skin tags are a benign condition and not directly associated with any other major medical conditions, since tags are commonly found on healthy people.

Is a skin tag a tumor?

Skin tags are a type of growth or tumor, albeit a completely benign and harmless one. Tags are not cancerous (malignant) and not found to have potential to become cancerous if left untreated.

What does a skin tag look like under a microscope?

The outer layer of the skin (the epidermis) shows overgrowth (hyperplasia), and it encloses an underlying layer of skin (the dermis) in which the normally-present collagen fibers appear abnormally loose and swollen. Usually there are no hairs, moles, or other skin structures present in skin tags.

What problems do skin tags cause?

These tiny skin growths generally cause no symptoms unless they are repeatedly irritated as, for example, by the collar or in the groin. Cosmetic removal for unsightly appearance is perhaps the most common reason they are removed. Occasionally, a tag may require removal because it has become irritated and red from bleeding (hemorrhage) or black from twisting and dying of the skin tissue (necrosis). Sometimes they may become snagged by clothing, jewelry, pets, or seatbelts, causing pain or discomfort. Overall these are very benign growths that have no cancer (malignant) potential.

Occasionally a tag may spontaneously fall off without any pain or discomfort. This may occur after the tag has twisted on itself at the stalk base, interrupting the blood flow to the tag.

What is Dysplastic Nevus?

A dysplastic nevus, (or naevus; pl. nevi or naevi) is an atypical melanocytic nevus; a mole whose appearance is different from that of common moles. Dysplastic nevi are generally larger than ordinary moles and have irregular and indistinct borders. Their color frequently is not uniform and ranges from pink to dark brown; they usually are flat, but parts may be raised above the skin surface. Dysplastic nevi can be found anywhere, but are most common on the trunk in men, and on the calves in women. In 1992, the NIH recommended that the term “dysplastic nevus” be avoided in favor of more descriptive language.

Cancer

According to the National Cancer Institute, doctors believe that dysplastic nevi are more likely than ordinary moles to develop into a type of skin cancer called melanoma. However, currently, most dermatologists do not believe that dysplastic nevi develop into melanomas. But individuals with multiple dysplastic nevi are at much higher risk for developing melanomas. Because of this, moles should be checked regularly by a doctor or nurse specialist, especially if they look unusual; grow larger; or change in color, or outline; or if any changes occur.

The controversy over the malignant potential of dysplastic nevi is highlighted by the publications and opinions of Dr. Clark and Dr. Ackerman. Essentially, Dr. Clark proposed that the melanocytic nevus evolve into a melanoma in stages - benign to dysplastic, then dysplastic to melanoma. Dr. Ackerman refuted this theory, by proposing that you either have a benign nevus, or a melanoma. There is no transition stage; and the melanoma is a melanoma on day one of its development. Today, most dermatologists believe that an individual with multiple dysplastic nevi do not need to have them all removed. The patient and doctor simply need to be exceedingly careful in identifying a melanoma growing among the dysplastic but benign lesions.

Self skin exam monthly is very important. Some dermatologist recommend that an individual with either histologic diagnosis of dysplastic nevus, or clinically apparent dysplastic nevi should be examined by an experienced dermatologist with dermatoscopy once a year (or more frequently).

A melanoma showing irregular borders and colour, diameter over 10 mm and asymmetry (ie A, B, C and D.)

To detect melanomas (and increase survival rates), it is recommended to learn what they look like (see “ABCDE” mnemonic below), to be aware of moles and check for changes (shape, size, color, itching or bleeding) and to show any suspicious moles to a doctor with an interest and skills in skin malignancy^.

A popular method for remembering the signs and symptoms of melanoma is the mnemonic “ABCDE”:

• Asymmetrical skin lesion.
• Border of the lesion is irregular.
• Color: melanomas usually have multiple colors.
• Diameter: moles greater than 6 mm are more likely to be melanomas than smaller moles.
• Evolution: The evolution (ie change) of a mole or lesion may be a hint that the lesion is becoming malignant.

The E is sometimes omitted, as in the ABCD guideline. A weakness in this system is the D. Many melanomas present themselves as lesions smaller than 6 mm in diameter; and likely all melanomas were melanomas on day 1 of growth, which is merely a dot a millimeter in size. An astute physician will examine all abnormal moles, including ones less than 6 mm in diameter. Unfortunately for the average person, many seborrheic keratosis, some lentigo senilis, and even warts breaks most if not all of the ABCD rules, and can not be distinguished from a melanoma without a trained eye or dermatoscopy.

A recent and novel method of melanoma detection is the “Ugly Duckling Sign” It is simple, easy to teach, and highly effective in detecting melanoma. Simply, correlation of common characteristics of a person’s skin lesion is made. Lesions which greatly deviate from the common characteristics are labeled as an “Ugly Duckling”, and further professional exam is required. The “Little Red Riding Hood” sign, suggests that individual with fair skin and light colored hair might have difficult to diagnose melanomas. Extra care and caution should be rendered when examining such individuals as they might have multiple melanomas and severely dysplastic nevi. A dermatoscope must be used to detect “ugly ducklings”, as many melanomas in these individuals resemble non-melanomas or are considered to be “wolves in sheep clothing”. These fair skinned individuals often have lightly pigmented or amelanotic melanomas which will not present with easy to observe color changes and variation in colors. The borders of these amelanotic melanomas are often indistinct, making visual identification without a dermatoscope (dermatoscopy) very difficult.

People with a personal or family history of skin cancer or of dysplastic nevus syndrome (multiple atypical moles) should see a dermatologist at least once a year to be sure they are not developing melanoma.

Maintaining Healthy Skin

The skin serves numerous functions - detoxifying, protecting, regulating - but the primary protective or barrier function is the most obvious. The top layer of skin cells has the most important function in maintaining the effectiveness of the barrier. Here the individual cells overlie each other and are tightly packed, preventing bacteria from entering and maintaining the water-holding properties of the skin.
Fatty substances (lipids) are secreted by the cells during the course of their journey from the base layer of the skin to the top. These lipid molecules join up and form a tough connecting network, in effect acting as the mortar between the bricks of a wall.

The cell wall barriers are simply layers of fats that surround the watery contents. Therefore, the communication mechanisms must operate through these fatty cell walls. In fact, many of the substances that are involved in this communication process are various fats since it is easiest for fats to move within the fatty layers that comprise the cell walls. Despite its bad reputation, proper fats and cellular fats are of major importance in our body’s biochemistry and physiology.

Damage to the skin barrier can result from a combination of genetic predisposion and exposure to sensitizing chemicals and other substances. That is why avoiding irritants is as important as using products that help. In skin care, the most common irritants are usually perfumes and preservatives.

Fatty substances control the majority of our body’s physiology through receptors that activate many important genes. Likewise, our skin barrier is comprised of a supporting structure of collagen, a protein that contains fats that serve a critical function. These fats prevent the excess loss of water through our skin and prevent the cells of our body from becoming dehydrated and dying.

A major sign of a defective skin is the dryness that results from excessive water loss. This water can not be applied topically but must be ingested. To prevent the excessive water loss and the resulting dry skin, we must repair the skin barrier. We find that the skin composition in individuals with dry skin is due to an improper mixture of the skin fats. This is commonly due to a deficiency in our diet of the correct fats, those contained in natural olive oils, avocados, and healthy nuts, etc. On a nutritional basis, we can provide these necessary fats through the skin sometimes through topical treatments containing natural butters or oils, like Shea, olive and cocoa butter. The epidermis is not a usual means to acquire nutrition but it can absorb enough fatty substances to correct the fat imbalances that are the cause of the defect in the skin’s barrier function and thus correct the dry, itchy skin or sensitive skin problem. Try to be aware of chemical preservatives in any topical products you do use.

Although many products today are labeled “fragrance free,” that is really a misnomer. Nearly all products contain some fragrance to mask their chemical odor; so-called fragrance-free products may just contain fewer chemicals than others. What’s more, the fragrances used in many products (even pricey perfumes) are commonly synthetic. For sensitive individuals, this chemical brew can be a problem To make matters worse, many natural fragrances are now extracted using harsh solvents rather than old-fashioned distillation methods, in which fewer chemicals come into contact with the essential oil of the flower. Unless you can determine the extraction method used, be cautious. This is one reason many individuals react negatively to the essential oils used in aromatherapy massages and related products – many are of a synthetic, chemical composition.

According to several studies, various preservatives including formaldehyde, parabens, and others commonly used in skin, hair, and beauty products can also provoke allergic reactions. Although the preservatives are needed to maintain product shelf life and only minute amounts are present in any given product, many products contain these same chemicals, including skin care products, makeup, medications, antiperspirants, toothpaste, and foods. Many of these products are used on a daily basis, causing a higher reaction rate. As a result, the overall exposure to these harmful ingredients is higher than would occur if only a single product were used. Studies show that massage therapists have more contact dermatitis – or skin inflammation - due to exposure to these extracts.

Until recently, few studies investigated the cumulative impact of repeated exposures to preservatives in a variety of products and ingredients. For the majority of people, these product preservatives are an additional benefit, not a problem. But, as the chemical compositions increase, so do the allergic reactions.
If you suffer from sensitive, allergic skin or severe dry skin, you may be among those who will have a problem or reaction to these chemical-laden products. In this case, it is your role as an informed consumer to carefully read labels for all products that come into contact with your skin - internally or externally- to assure that they don’t contain the listed ingredients that you must avoid. Your skin barrier does a lot to protect you naturally, help it out when you can and feed it nourishing chemical-free products whenever you can.