Abstract
Acrochordons or fibroepithelial polyps, are very common skin lesions. However, giant acrochordons are extremely rare. We present a case of a morbidly obese diabetic man who was treated with primary excision of a giant 18 cm acrochordon of the left axilla.
Background
Acrochordons, commonly known as skin tags, are growths of ectodermal and mesodermal components, and are present in 25% of the general population.1 2 Rare reports of giant acrochordons have appeared in the literature. We present a case of a patient who was treated with simple excision of an 18 cm left axillary acrochordon.
Case presentation
A 41-year-old-man presented with a painful left axillary mass that had been growing for 2 years. He denied any history of similar lesions, lymph node enlargement or weight loss. His medical history was significant for untreated diabetes, hypertension and narcolepsy. He had never undergone surgery prior to this admission. He had no family history of chronic diseases or cancer.
On examination, his temperature was 37°C, heart rate 80 bpm, blood pressure 135/71 mm Hg and respiratory rate 17 breaths/min. His height was 183 cm and weight was 133 kg; he had a body mass index of 39.8 kg/m2. There was an 18 cm left axillary non-tender pedunculated mass that was firm, with no appreciated axillary lymphadenopathy (figure 1).
Figure 1.
Left axillary mass measuring 18 cm in greatest diameter.
Investigations
The patient's blood glucose level was 151 mg/dL and his glycated haemoglobin was 7.4%.
CT of the chest and axilla showed a large polypoid soft tissue mass arising from the skin of the proximal left upper arm, with borderline enlarged left axillary lymph nodes.
Differential diagnosis
Dermatofibroma
Kertoacanthoma
Acrochordon
Epidermal inclusion cyst
Treatment
An incisional biopsy of the mass was performed, and pathological examination revealed benign skin overlying a mixture of benign stroma and clusters of adipocytes consistent with a fibrolipomatous variant of acrochordon.
The patient was taken to the operating room 4 days later and the mass was excised. Surgical pathology showed an 18 cm benign fibroepithelial polyp (acrochordon; figures 2 and 3). The patient was discharged on postoperative day 1 and had no postoperative complications.
Figure 2.
Gross pathology examination of the resected specimen weighing 322 g.
Figure 3.
Microscopic examination revealing a benign fibroepithelial polyp.
Outcome and follow-up
The patient had no postoperative complications and his wound was healing well on his postoperative clinic visit 2 weeks later.
Discussion
Acrochordons represent fibroepithelial polyps and originate from ectoderm and mesoderm. They are commonly known as skin tags.1 The prevalence in the general population is 25% and obesity is a predisposing factor.2 They usual range in size between 1 and 10 mm, however, a few case reports have described giant acrochordons. Choudhary3 reported a case of an 8 inch thigh acrochordon, which was treated with shave excision and electrodessication. Ilango et al4 reported a 55-year-old patient with a 12 cm acrochordon of the back, which was excised surgically. Our patient had an unusually large acrochordon.
An association between skin tags and insulin resistance has been previously described; these lesions may represent a marker for increased risk of cardiovascular disease.5 6 This patient's insulin resistance, as evidenced by his morbid obesity and diabetes, may have contributed to the development of this giant acrochordon.
Learning points.
Acrochordons are common small benign fibroepithelial polyps, but, rarely, can grow to unusually large sizes.
They have an association with insulin resistance and metabolic syndrome.
The treatment is simple excision, which is curative.
Acknowledgments
The authors would like to acknowledge Myra Zucker, PA-C, UNM Department of Pathology, for the specimen photographs.
Footnotes
Contributors: EA gathered and analysed the data, performed the literature review, prepared and edited the manuscript and the guarantor. SP contributed to data acquisition and analysis. JR performed data analysis, as well as manuscript preparation and editing.
Competing interests: None declared.
Patient consent: Not obtained.
Provenance and peer review: Not commissioned; externally peer reviewed.
References
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