Wart Treatment by Type of Drug and Procedure

The new advance in treatment of genital warts has been imiquimod (Aldara). This encourages the patient’s autoimmune system to attack the wart. This is particularly helpful in the moist areas of the skin or mucosal surfaces.

Salicylic acid
Salicylic acid can be applied either in the form of plasters or as liquid on to the warts. This will break down the thickened skin on the surface. It is more effective if the area is covered. These are useful for warts on the hands, knees and feet. They do turn the skin white. They can be used in combination with paring of the warts. Treatment with these at nighttime and covering with duct tape can be effective although slow.

Podophyllin

Podophyllin has a long history of use. It is useful mostly in genital warts. It should be applied very carefully on the warts, trying to prevent spread on to normal skin. It should be washed off after a few hours. There is irritation usually for a few days. Repeat treatments are usually required. A more purified form of podophyllin called podophyllotoxin is available for patient use. It can be used once or twice daily for a few days in succession. This produces some irritation. It has the advantage of not being as irritating as podophyllin and can be applied by the patients themselves.

Vitamin Acid

Vitamin acid (Tretinoin) is a vitamin A preparation. It is used in the treatment of acne and photo damage. Vitamin A products tend to regulate the surface of the skin, generally trying to keep the epidermis behaving normally. It may also cause some inflammation. In some individuals it can help reduce or even eliminate warts.

Cantharone

Cantharone (cantharidin) is derived from an insect. It can be very helpful in children but the application is painful. Inflammation and
blistering usually occurs later in the day, after application. Multiple treatments may be required. There are two concentrations. The
stronger version combines Cantharone with podophyllin and salicylic acid. Very occasionally the blistering reaction can be quite severe
and associated with swelling and pain. It is often very effective even in resistant warts.

Cryotherapy

Cryotherapy is the use of liquid nitrogen. This can be applied either with a Q-Tip or it can be sprayed on to the skin. It causes destruction by freezing water inside the cells. This damages the cell causing death. It is painful to apply and there is blistering associated with this. Multiple treatments may be required. Thawing and freezing again makes this therapy more effective. It can be a problem in dark skin in that it can either increase or decrease pigmentation, which can be permanent. This treatment can be used in combination with other therapies.

Electrodesiccation

Electrodesiccation is the use of an electric needle to burn warts. It usually requires a local anesthetic. It does have a potential risk of scarring. Very large warts can sometimes be scraped off before they are cauterized.

CO2 Laser

The CO2 laser has been used for many years. It essentially vaporizes water in the skin and causes destruction. It leaves a hole in the skin which will heal. There is often scarring with this technique. Other lasers such as the pulse dye laser are easier to use. The yellow light is absorbed by blood in the vessels that feed the warts. This is a similar laser used in the treatment of red birthmarks. The pulse dye laser at a high power setting can be effective particularly if multiple pulses are used in succession.

Aldara

Aldara is an immune response modulator. It boosts the patient’s immune response to viruses. It can also encourage the production of a lasting immune memory. It has been available in Canada since 1999. It works best in the genital area as penetration into the skin is easier. When it is used elsewhere it often has to be covered to help with penetration into the skin. It has been shown to work well particularly in women. It is applied three times weekly. There will be some inflammation associated with this. The results may be enhanced by combining this with liquid nitrogen. This drug has added a very significant tool in treating genital warts.

Identifying Skin Lesions - Warts, Moles and SebKs

By Van Le |  While freckles can add to a person’s beauty and uniqueness, other skin lesions such as large moles, skin tags, warts, and seborrheic keratoses can be unsightly and embarrassing. Most lesions are malignant (non-cancerous), however, it is important to be aware of and track any skin abnormalities on your body as a preventative measure.

Freckles

Freckles are irritating for some and embraced by others. They are pigment cells that retain within the skin to form light brown spots, and individuals with lighter complexions are more susceptible to freckles since their skin contains less melanin. Freckles, also known as ephelides, can appear on the face, arms and other sun-exposed areas. Excessive and continued exposure to harmful UV rays can cause more freckles and cause them to appear darker. While they are harmless, it is important to distinguish between freckles and symptoms of melanoma, a type of skin cancer that can grow from an existing freckle. Consult your doctor if you notice any change in freckle size, shape and color.

Skin tags

Skin tags are pieces of skin that hang from the surface of a surrounding area. Like freckles, they are benign, but can cause irritation if located on an area that is exposed to constant contact, such as the eyelids or areas where they can be snagged by jewelry or clothing. Skin tags can vary from a small pin-point size to a large grape size. While some can fall off on their own, there are several ways to medically remove skin tags, including freezing and burning. There are home remedies as well as creams available on the market to remove unwanted and embarrassing skin tags.

Seborrheic keratoses

Seborrheic keratoses, another benign skin lesion, can form anywhere on the body, but is commonly found on the chest and back. They can be distinguished from other types of lesions due to their waxy, stuck-on-the-skin appearance and often described as brown candle wax stuck on the skin. While the cause is still unknown, scientists have found that they can be hereditary and not affected by sun exposure.

Warts

Most warts are skin infections caused by viruses of the human papillomavirus (HPV) family. Basically, warts are benign tumors of the epidermis (outer layer of skin), and can occur in people of all ages, but are most commonly found on children and teenagers. There are different types, including flat and plantar warts. Flat warts are small in size but can be high in quantity, can spread to other areas of the body by shaving or scratching, and can be transferred person-to-person by physical contact. Plantar warts grow on the heel, ball or sole of the foot, and pressure from standing or walking pushes them into the deeper layers of skin.

Skin lesions like warts, seborrheic keratoses and skin tags are often harmless, but they can be embarrassing. While they can be surgically removed, there are creams and ointments available on the market to remove and reduce their appearance. If you have further questions about a particular skin lesion, consult your doctor or pharmacist for proper diagnosis and treatment.

Van Le is a staff writer for the CSU Daily Titan and writing intern for Vivoderm Laboratories in Los Angeles, California. She is currently pursuing a Journalism degree at California State University, Fullerton.

For the latest findings on skin lesions and treatments, you can also link to http://www.removalofwart.com

The Warning Signs of Melanoma

The A, B, C, D, Es of Melanoma.  Moles, brown spots and growths on the skin are usually harmless — but not always. Anyone who has more than 100 moles is at greater risk for melanoma. The first signs can appear in one or more atypical moles. That’s why it’s so important to get to know your skin very well and to recognize any changes in the moles on your body. Look for the ABCDEs of melanoma, and if you see one or more, make an appointment with a physician immediately.

Melanoma - What You Need to Know

Hearing the words “It’s cancer” can be overwhelming. Often, people are too stunned to be able to ask physicians for the information they need. When discussing your diagnosis and treatment options with your physician, it can be helpful to have questions prepared ahead of time, so that you don’t forget anything important. Take a pen and paper to write down the answers, or a portable tape recorder so that you can play back the answers later. Studies have shown that people who are more informed about their cancer have a more positive attitude and respond better to treatment.

Questions to Ask Your Physician

• How advanced is my melanoma? What stage is it in?
• What are my chances of recovery?
• What treatments are available?
• Will I be given a choice of options?
• If I need surgery, will there be a scar?
• Which treatment do you think is best for me? Why?
• What are the side effects? Can they be treated, too?
• Will my health insurance or Medicare/Medicaid cover the cost?
• Will I be able to work and lead a normal life during treatment?
• What tests will be performed to show that the melanoma is cured?
• What are the chance of it coming back?
• Is there anything I can do to prevent a recurrence?

	Asymmetry If you draw a line through this mole, the two halves will not match.
	Border The borders of an early melanoma tend to be uneven. The edges may be scalloped or notched.
	Color Having a variety of colors is another warning signal. A number of different shades of brown, tan or black could appear. A melanoma may also become red, blue or some other color.
	Diameter Melanomas usually are larger in diameter than the size of the eraser on your pencil (1/4 inch or 6 mm), but they may sometimes be smaller when first detected.
	Evolving Any change — in size, shape, color, elevation, or another trait, or any new symptom such as bleeding, itching or crusting — points to danger.

Prompt action is your best protection. The pictures below show atypical normal moles and melanomas.

	Benign	Malignant
Symmetrical			Asymmetrical
Borders are even			Borders are uneven
One shade			Two or more shades
Smaller than 1/4 inch			Larger than 1/4

Actinic Keratosis and Other Precancers

THE MOST COMMON PRECANCER :  More Than Ten Million

This figure is generally accepted as the best current estimate of the number of Americans with actinic keratosis (AK). People with a fair complexion, blond or red hair, and blue, green or grey eyes (Identify Your Skin Type) have a high likelihood of developing one or more of these common precancers if they spend time in the sun and live long enough. Location makes a difference: The closer to the equator you live, the more likely you are to have actinic keratoses.

The incidence is slightly higher in men, because they tend to spend more time in the sun and use less sun protection than women do. African-
Americans, Hispanics, Asians and others with darker skin are not as susceptible as Caucasians (Skin Cancer and Skin of Color).

Is There Cause for Concern?

Actinic keratosis can be the first step leading to squamous cell carcinoma and is therefore known as a “precancer.” Although the vast majority of actinic keratoses remain benign, some studies report that up to ten percent may advance to squamous cell carcinoma. This percentage does not sound very large, but it has a large impact. When it comes to squamous cell carcinomas, 40-60 percent begin as untreated actinic keratoses and may advance to invade the surrounding tissues. About 2 to 10 percent of these squamous cell carcinomas spread to the internal organs and are life-threatening.

Another form of actinic keratosis, actinic cheilitis, develops on the lips and may evolve into squamous cell carcinoma.

The more keratoses you have, the greater the chance that one or more may turn into skin cancer. In fact, some scientists interpret actinic keratosis as the earliest form of squamous cell carcinoma.

What Is Actinic Keratosis?

An actinic keratosis, also known as a solar keratosis, is a scaly or crusty growth (lesion). It most often appears on the bald scalp, face, ears, lips,
backs of the hands and forearms, shoulders, neck or any other areas of the body frequently exposed to the sun. You’ll most often see the plural,
“keratoses,” because there is seldom just one.

In the beginning, actinic keratoses are frequently so small that they are recognized by touch rather than sight. It feels as if you were running a finger over sandpaper. There are many times the number of invisible (subclinical) lesions as visible ones on the skin surface.

Most often, actinic keratoses develop slowly and reach a size from an eighth to a quarter of an inch. Early on, they may disappear only to reappear later. Most become red, but some will be light or dark tan, pink, red, a combination of these, or the same color as your skin. Occasionally they itch or produce a pricking or tender sensation. They can also become inflamed and surrounded by redness. In rare instances, actinic keratoses can even bleed.

If you have actinic keratoses, it indicates that you have sustained sun damage and could develop any kind of skin cancer – not just squamous cell carcinoma.

Actinic keratosis on the back of the hand. These precancers commonly occur on the face and the back of the hands.

A closeup shows elevation, roughness, and crusting. Some keratoses, like this one, are quite discrete and difficult to distinguish clinically from squamous cell carcinoma.

How to Recognize Actinic Keratosis

Examples of typical actinic keratoses are shown here, so examine your skin regularly for lesions that look like them. But it’s not always that simple:

Many actinic keratoses have quite a different appearance, so if you find any unusual or changing growth, be suspicious and see your doctor promptly.

Numerous actinic keratoses can reveale chronic sun damage. They are elevated, rough in texture, and resemble warts.

Two typical keratoses on rim of ear. The top lesion is crusted, the lower one rough in appearance.

While most keratoses have a fine sandpapery roughness, others such as this lesion have an obviously scaly, crusty surface.

Chronic sun exposure is the cause of almost all actinic keratoses. Sun damage to the skin is cumulative, so even a brief period in the sun adds to the lifetime total. Cloudy days aren’t safe either, because 70-80 percent of solar ultraviolet (UV) rays can pass through clouds. These harmful rays can also bounce off sand, snow and other reflective surfaces, giving you extra exposure.

The ultraviolet radiation given off by the lamps in a tanning salon can be even more dangerous than the sun, so dermatologists warn against indoor tanning.

Occasionally, actinic keratoses may be caused by extensive exposure to X-rays or a number of industrial chemicals.

What Age Has to Do with It

Because the total amount of time spent in the sun adds up year by year, older people are most likely to develop actinic keratoses. However, nowadays, some individuals in their 20s are affected. Still, actinic keratoses become much more common in people over the age of 50. Some experts believe almost everyone over 80 has actinic keratoses.

Also, individuals whose immune defenses are weakened by cancer chemotherapy, AIDS, organ transplantation or excessive UV exposure are less able to fight off the effects of the radiation and thus more likely to develop actinic keratoses.

A PUBLICATION OF THE SKIN CANCER FOUNDATION
For more information or to order this article as a brochure, please contact:
The Skin Cancer Foundation
149 Madison Ave., Suite 901,
New York, NY 10016
© 2008

Photos courtesy of:
Pearon G. Lang, Jr., MD, and
MSKCC Dept. of Dermatology
Photos courtesy of:
Pearon G. Lang, Jr., MD, and
Memorial Sloan Kettering Cancer Center
Deptartment of Dermatology

Actinic Keratosis Treatments

What Is Actinic Keratosis?

An actinic keratosis, also known as a solar keratosis, is a scaly or crusty growth (lesion). It most often appears on the bald scalp, face, ears, lips,
backs of the hands and forearms, shoulders, neck or any other areas of the body frequently exposed to the sun. You’ll most often see the plural,
“keratoses,” because there is seldom just one.

In the beginning, actinic keratoses are frequently so small that they are recognized by touch rather than sight. It feels as if you were running a finger over sandpaper. There are many times the number of invisible (subclinical) lesions as visible ones on the skin surface.

Most often, actinic keratoses develop slowly and reach a size from an eighth to a quarter of an inch. Early on, they may disappear only to reappear later. Most become red, but some will be light or dark tan, pink, red, a combination of these, or the same color as your skin. Occasionally they itch or produce a pricking or tender sensation. They can also become inflamed and surrounded by redness. In rare instances, actinic keratoses can even bleed.

If you have actinic keratoses, it indicates that you have sustained sun damage and could develop any kind of skin cancer – not just squamous cell carcinoma.

How to Recognize Actinic Keratosis

Examples of typical actinic keratoses are shown here, so examine your skin regularly for lesions that look like them. But it’s not always that simple:

Many actinic keratoses have quite a different appearance, so if you find any unusual or changing growth, be suspicious and see your doctor promptly. Numerous actinic keratoses can reveale chronic sun damage. They are elevated, rough in texture, and resemble warts.

Two typical keratoses on rim of ear. The top lesion is crusted, the lower one rough in appearance.

While most keratoses have a fine sandpapery roughness, others such as this lesion have an obviously scaly, crusty surface.

Chronic sun exposure is the cause of almost all actinic keratoses. Sun damage to the skin is cumulative, so even a brief period in the sun adds to the lifetime total. Cloudy days aren’t safe either, because 70-80 percent of solar ultraviolet (UV) rays can pass through clouds. These harmful rays can also bounce off sand, snow and other reflective surfaces, giving you extra exposure.

The ultraviolet radiation given off by the lamps in a tanning salon can be even more dangerous than the sun, so dermatologists warn against indoor tanning.

Occasionally, actinic keratoses may be caused by extensive exposure to X-rays or a number of industrial chemicals.

What Age Has to Do with It

Because the total amount of time spent in the sun adds up year by year, older people are most likely to develop actinic keratoses. However, nowadays, some individuals in their 20s are affected. Still, actinic keratoses become much more common in people over the age of 50. Some experts believe almost everyone over 80 has actinic keratoses.

Also, individuals whose immune defenses are weakened by cancer chemotherapy, AIDS, organ transplantation or excessive UV exposure are less able to fight off the effects of the radiation and thus more likely to develop actinic keratoses.

Why Is It Treated?

While actinic keratosis is the most common precancer, not all keratoses turn into cancers. Unfortunately, there is no way to know ahead of time which actinic keratoses are precursors of squamous cell carcinoma. That is why it is fortunate that there are so many effective treatments for eliminating actinic keratoses.

When an actinic keratisis is suspected to be an early cancer, the physician may take tissue for biopsy. This is done by shaving off the top of the lesion with a scalpel or scraping it off with a curette. Local anesthesia is required. Bleeding is usually stopped with a styptic agent.

TOPICAL MEDICATIONS

Medicated creams and solutions are very effective by themselves or in combination with another form of treatment when a person has many actinic keratoses.

5-fluorouracil (5-FU) ointment or liquid in concentrations from 0.5 to 5 percent has FDA approval and is the most widely used topical treatment for actinic keratoses. It is effective against not only the surface lesions but also the subclinical ones. Rubbed gently onto the lesions once or twice a day for two to four weeks, it produces cure rates of up to 93 percent. Reddening, swelling and crusting may occur, but they are temporary. The lesions usually heal within two weeks of stopping treatment. There is rarely scarring and the cosmetic result is good.

Imiquimod 5% cream, also FDA-approved, works in a different way: It stimulates the immune system to produce interferon, a chemical that destroys  cancerous and precancerous cells. It is rubbed gently on the lesion twice a week for four to sixteen weeks. The cream is generally well tolerated, but some individuals develop redness and ulcerations.

Diclofenac is a non-steroidal anti-inflammatory drug used in combination with hyaluronic acid, a chemical found naturally in the body. The resulting gelis applied twice a day for two to three months. The diclofenac prevents an inflammatory response, so this topical is well-tolerated, and the hyaluronic acid delays uptake of the diclofenac, leading to higher concentrations in the skin. It is used in persons who are oversensitive to other topical treatments.

CRYOSURGERY

This is the most commonly used treatment method when a limited number of lesions exist. No cutting or anesthesia is required. Liquid nitrogen, applied with a spray device or cotton-tipped applicator, freezes the growths. The lesions subsequently shrink or become crusted and fall off. Temporary redness and swelling may occur after treatment, and in some patients, white spots may remain permanently.

COMBINATION THERAPIES

If one form of therapy is good, two may be better; some of the treatment options described here are especially effective when used together or in sequence. This approach can both improve the cure rate and reduce side effects. One to two weeks of 5-FU followed by cryosurgery can reduce the healing time for 5-FU and decrease the likelihood of white spots following cryosurgery.

CHEMICAL PEELING

This method, best known for reversing the signs of photoaging, is also used to remove some actinic keratoses on the face. Trichloroacetic acid (TCA) and/or similar chemicals are applied directly to the skin. The top skin layers slough off and are usually replaced within seven days. This technique requires local anesthesia and can cause temporary discoloration and irritation.

LASER SURGERY

A carbon dioxide or erbium YAG laser is focused onto the lesion, and the beam cuts through tissue without causing bleeding. This is a good option for lesions in small or narrow areas, and, therefore, can be particularly effective for keratoses on the face and scalp, as well as actinic cheilitis on the lips.

However, local anesthesia may be necessary, and some pigment loss can occur. Lasers are useful for people taking blood thinners or as a secondarytreatment when others have not succeeded.

PHOTODYNAMIC THERAPY (PDT)

PDT can be especially useful for lesions on the face and scalp. Topical 5-aminolevulinic acid (5-ALA), a photosensitizing agent, is applied to thelesions. Subsequently, the medicated area is exposed to strong light that activates 5-ALA. The treatment selectively destroys actinic keratoses, causing little damage to surrounding normal skin, although some swelling and redness often occur.

How to Prevent Actinic Keratosis

The best way to prevent actinic keratosis is to protect yourself from the sun. Here are some sun-safety habits that really work.

* Seek the shade, especially between 10 A.M. and 4 P.M.
* Do not burn.
* Use a sunscreen with an SPF of 15 or higher every day.

* Apply 1 ounce (2 tablespoons) of sunscreen to your entire body 30 minutes before going outside. Reapply every two hours or immediately after  swimming or excessive sweating.
* Cover up with clothing, including a broad-brimmed hat and UV-blocking sunglasses.
* Keep newborns out of the sun. Sunscreens should be used on babies over the age of six months.
* Examine your skin head-to-toe every month.
* See your doctor every year for a professional skin exam.
* Avoid tanning and UV tanning salons.

Medical Reviewers:
Rex A. Amonette, MD
David J. Leffell, MD
Perry Robins, MD

A PUBLICATION OF THE SKIN CANCER FOUNDATION
For more information or to order this article as a brochure, please contact:
The Skin Cancer Foundation
149 Madison Ave., Suite 901,
New York, NY 10016
© 2008

Photos courtesy of:
Pearon G. Lang, Jr., MD, and
MSKCC Dept. of Dermatology
Photos courtesy of:
Pearon G. Lang, Jr., MD, and
Memorial Sloan Kettering Cancer Center
Deptartment of Dermatology

Milia and Seborrheic Keratosis

Milia, also known as milk spots or oil seeds, are benign, keratin-filled cysts that can appear just under the epidermis or on the roof of the mouth. They are commonly associated with newborn babies but can appear on people of all ages. They are usually found around the nose and eyes, and sometimes on the genitalia, often mistaken by those infected as warts or other STDs.

In children milia often disappears within two to four weeks. In adults it may require removal by a physician or an esthetician. Milia can sometimes be a result of harsh face washes or from repeated heat stress from hot showering on people with sensitive skins. Milia can be confused with stubborn whiteheads.

A seborrheic keratosis (also known as “Seborrheic verruca,” “Senile keratosis,” and “Senile wart”) is a noncancerous benign skin growth that originates in keratinocytes. Like liver spots, seborrheic keratoses are seen more often as people age. In fact they are sometimes humorously referred to as the “barnacles of old age”.

They appear in various colors, from light tan to black. They are round or oval, feel flat or slightly elevated (like the scab from a healing wound), and range in size from very small to more than 2.5 centimetres (1.0 in) across. They can resemble warts, though they have no viral origins. They can also resemble melanoma skin cancer, though they are unrelated to melanoma as well. Because only the top layers of the epidermis are involved, seborrheic keratoses are often described as having a “pasted on” appearance. Some dermatologists refer to seborrheic keratoses as “seborrheic warts”, however these lesions are usually not associated with HPV, and therefore such nomenclature should be discouraged.

Classification

Seborrheic keratoses may be divided into the following types:

* Common seborrheic keratosis (Basal cell papilloma, Solid seborrheic keratosis)
* Reticulated seborrheic keratosis (Adenoid seborrheic keratosis)

Reticulated seborrheic keratosis (also known as “Adenoid seborrheic keratosis”) is a common benign cutaneous condition characterized by a skin lesion with a dull or lackluster surface, and with keratin cysts seen histologically.

* Stucco keratosis (Digitate seborrheic keratosis, Hyperkeratotic seborrheic keratosis, Serrated seborrheic keratosis, Verrucous seborrheic

keratosis) Stucco keratosis (also known as “Digitate seborrheic keratosis,” “Hyperkeratotic seborrheic keratosis,” “Serrated seborrheic keratosis,” and “Verrucous seborrheic keratosis”) is a common benign cutaneous condition characterized by a skin lesion with a dull or lackluster surface, and with church-spire-like projections of epidermal cells around collagen seen histologically.

* Clonal seborrheic keratosis
Clonal seborrheic keratosis is a common benign cutaneous condition characterized by a skin lesion with a dull or lackluster surface, and with round, loosely packed nests of cells seen histologically.

* Irritated seborrheic keratosis (Basosquamous cell acanthoma, Inflamed seborrheic keratosis)

* Seborrheic keratosis with squamous atypia

Seborrheic keratosis with squamous atypia is a less common cutaneous condition characterized by a skin lesion with a dull or lackluster surface, and with round, loosely packed nests of cells seen histologically.

* Melanoacanthoma (Pigmented seborrheic keratosis)

Melanoacanthoma (also known as “Pigmented seborrheic keratosis”) is a common, benign, darkly pigmented cutaneous condition characterized by a skin lesion with a dull or lackluster surface.

* Dermatosis papulosa nigra

Dermatosis papulosa nigra (DPN) is a condition of many small, benign skin lesions on that face that closely simulate seborrheic keratoses, a condition generally presenting on dark-skinned individuals.

They should not be confused for Leser-Trélat sign, a sudden explosion of lesions due to a growing tumor.

* The sign of Leser-Trélat

The Leser-Trélat sign is the explosive onset of multiple seborrheic keratoses (many pigmented skin lesions), often with an inflammatory base. This can be an ominous sign of internal malignancy as part of a paraneoplastic syndrome. In addition to the development of new lesions, preexisting ones frequently increase in size and become symptomatic. It is named for Edmund Leser and Ulysse Trélat.

Although most associated neoplasms are gastrointestinal adenocarcinomas (stomach, liver, colorectal and pancreas), breast, lung, and urinary tract cancers, as well as lymphoid malignancies are associated with this impressive rash. It is likely that various cytokines and other growth factors produced by the neoplasm are responsible for the abrupt appearance of the seborrheic keratoses. In some cases, paraneoplastic acanthosis nigricans accompanies the sign of Leser-Trélat.

Variances of Seborrheic Keratosis:

Dermatosis Papulosis Nigra: Often are small papules. Pinpoint to a few millimeters in size. More commonly found in dark-skinned persons.

Stucco Keratosis: Often are light brown to off-white. Pinpoint to a few millimeters in size. Often found on the distal tibia, ankle, and foot.

Diagnosis: Visual diagnosis is made by the “stuck on” appearance, horny pearls or cysts embedded in the structure. Darkly pigmented lesions can be hard to distinguish from nodular melanomas. If in doubt, a skin biopsy should be performed. Thin seborrheic keratoses on facial skin can be very difficult to differentiate from lentigo maligna even with dermatoscopy.

Clinically, epidermal nevi are similar to seborrheic keratoses in appearance. Epidermal nevi are usually present at or near birth. Condylomas and warts can clinically resemble seborrheic keratoses, and dermatoscopy can be helpful. On the penis and genital skin, differentiation between condylomas and seborrheic keratoses can be difficult and may require a skin biopsy.

Treatment
When correctly diagnosed, no treatment is necessary. There is a small risk of localized infection caused by picking at the lesion. If a growth becomes excessively itchy or is irritated by clothing or jewelry, it can be removed by cryosurgery.

Small lesions can be treated with light electrocautery. Larger lesions can be treated with electrodessication and curettage, shave excision, or cryotherapy. When correctly performed, removal of seborrheic keratoses will not cause much visible scarring except in darkly colored persons.

Cause
The cause of seborrheic keratosis is unclear. Because they are common on sun-exposed areas such as the back, arms, face, and neck, ultraviolet light

may play a role, as may genetics.[8] A mutation of a gene coding for a growth factor receptor, (FGFR3), has been associated with seborrheic keratosis.

Etymology
The term “seborrheic keratosis” combines the adjective form of seborrhea, keratinocyte (referring to the part of the epidermis that produces keratin), and the suffix -osis, meaning abnormal.

How are skin tags treated?

There are several effective medical ways to remove a skin tag, including removing with scissors, freezing (using liquid nitrogen), and burning (using medical electric cautery at the physician’s office).

Usually small tags may be removed easily without anesthesia while larger growths may require some local anesthesia (injected lidocaine) prior to removal. Application of a topical anesthesia cream prior to the procedure may be desirable in areas where there are a large number of tags.

Dermatologists (skin doctors), family physicians, and internal medicine physicians are the doctors who treat tags most often. Occasionally, an eye specialist (ophthalmologist) is needed to remove tags very close to the eyelid margin.

There are also home remedies and self-treatments, including tying off the small tag stalk with a piece of thread or dental floss and allowing the tag to fall off over several days.

The advantage of scissor removal is that the growth is immediately removed and there are instant results. The potential disadvantage of any kind of scissor or minor surgical procedure to remove tags is minor bleeding.

Possible risks with freezing or burning include temporary skin discoloration, need for repeat treatment(s), and failure for the tag to fall off.

There is no evidence that removing tags causes more tags to grow. Rather, there are some people that may be more prone to developing skin tags and may have new growths periodically. Some patients even require periodic removal of tags at annual or quarterly intervals.

Do skin tags need to be sent for pathology?

Most typical small skin tags may be removed without sending tissue for microscopic examination. However, there are some larger or atypical growths that may be removed and sent to a pathologist for examination under a microscope to make sure that the tissue is really a tag and nothing more. Additionally, skin bumps that have bled or rapidly changed may also need pathologic examination. While extremely rare, there are a few reports of skin cancers found in skin tags.

What else could it be?

While classic skin tags are typically very characteristic in appearance and occur in specific locations such as the underarms, necks, under breasts, eyelids and groin folds, there are tags that may occur in less obvious locations.

Other skin growths that may look similar to a skin tag but are not tags include moles (dermal nevus), nerve and fiber-type moles (neurofibromas), warts, and “barnacles” or “Rice Krispies” (seborrheic keratosis).

Warts tend to be rougher, with a “warty” irregular surface whereas skin tags are usually smooth. Warts tend to be flat whereas tags are more like bumps hanging from thin stalk. While warts are almost entirely caused by human papilloma virus (HPV), tags are only sometimes associated with HPV.

Groin and genital lesions resembling skin tags may actually be genital warts or condyloma. A biopsy would help diagnose which of these growths are not skin tags. Very rarely, a basal cell skin or squamous cancer or melanoma may mimic a skin tag, but this is very uncommon.

Is there another medical name for a skin tag?

Medical terms your physician or dermatologist may use to describe a skin tag include fibroepithelial polyp, acrochordon, cutaneous papilloma, and soft fibroma. All of these terms describe skin tags and are benign (noncancerous), painless skin growths. Some people refer to these as “skin tabs” or warts. However, a skin tag is best known as a skin tag.

Skin Tag At A Glance

• A skin tag is a common but harmless skin growth.
• Skin tags are frequently found on the eyelids, neck, chest, armpits, and groin.
• Treatments include freezing, tying off with a thread or suture, or cutting off.