SKIN TAGS (ACROCHORDONS) & FIBROEPITHELIAL POLYPS

CLINICAL OVERVIEW & MANAGEMENT APPROACH

Skin tags, medically referred to as acrochordons, are common benign skin growths composed of fibrous tissue and skin. They are typically pedunculated, meaning they are attached to the skin by a narrow stalk, and range in size from very small, soft lesions to larger, more prominent growths.

Larger or more developed skin tags are often referred to as fibroepithelial polyps. While the terms are sometimes used interchangeably, fibroepithelial polyps are generally larger, thicker, and more fibrous, and are more likely to become inflamed, irritated, or symptomatic.

Both skin tags and fibroepithelial polyps are benign and most commonly occur in areas of repetitive friction, including the neck, underarms, eyelids, groin, beneath the breasts, and along skin folds.

CLINICAL DISTINCTIONS

Although skin tags share a benign origin, size and behavior may influence evaluation and management.

SMALL SKIN TAGS

• Soft, flesh-colored
• Typically asymptomatic
• Commonly removed for cosmetic reasons

FIBROEPITHELIAL POLYPS

• Larger, thicker, or more fibrous
• More prone to inflammation, swelling, pain, or bleeding
• More likely to be injured by clothing, jewelry, or shaving
• May require medical evaluation and, in some cases, biopsy

WHY MEDICAL EVALUATION MATTERS

While many skin tags are straightforward, not all pedunculated lesions are identical. Larger or inflamed fibroepithelial polyps may:

• Mimic other benign or malignant skin lesions
• Become painful or bleed due to torsion or repeated trauma
• Require diagnostic confirmation prior to treatment

For this reason, clinical evaluation is recommended before removal—particularly for lesions that are large, pigmented, inflamed, rapidly changing, or recurrently injured.

WHEN DIAGNOSTIC CONFIRMATION IS REQUIRED

In certain situations, histopathologic confirmation may be required prior to definitive treatment.

A biopsy may be necessary when:
• Diagnosis is uncertain on clinical or dermoscopic examination
• The lesion is pigmented, atypical, or rapidly changing
• There is concern for malignancy
• Pathology confirmation is required to establish medical necessity

Biopsy ensures accurate diagnosis and appropriate treatment selection.

MEDICAL VS. COSMETIC CARE

• Medical treatment addresses symptoms, injury, or diagnostic concern
• Cosmetic treatment is elective and intended to improve appearance only

This distinction is discussed clearly during consultation, including insurance coverage considerations and self-pay options.

MEDICALLY NECESSARY TREATMENT OPTIONS

When skin tags or fibroepithelial polyps are symptomatic or diagnostically concerning, treatment may be considered medically necessary.

SHAVE REMOVAL / BIOPSY

• Commonly used for raised or inflamed lesions
• Allows symptom relief and diagnostic confirmation
• Tissue may be submitted for pathology when indicated

SURGICAL EXCISION

• Used for larger or repeatedly inflamed fibroepithelial polyps
• Allows complete removal
• Enables histopathologic evaluation when required

Pathology review may be necessary to support medical necessity and insurance authorization.

COSMETIC TREATMENT OPTIONS OFFERED AT IVSI

When no medical indication is present, removal may be performed for cosmetic reasons.

METHODS OF SKIN TAG REMOVAL AT IVSI

At International Vein & Skin Institute, skin tag removal is performed using methods selected to minimize bleeding, reduce tissue trauma, and improve healing, particularly in sensitive or high-friction areas.

Many patients present after prior treatment elsewhere and seek care due to incomplete removal, recurrence, bleeding, or scarring.

LIMITATIONS OF TRADITIONAL REMOVAL METHODS

Common techniques used outside our practice include:
• Cutting with surgical scissors
• Electrocautery
• Cryotherapy (freezing)

These methods may be associated with:
• Bleeding during or after removal
• Prolonged inflammation or tenderness
• Surrounding tissue injury or scarring
• Incomplete removal of the lesion base, increasing recurrence risk

These complications are among the most frequent reasons patients seek second opinions.

WHY IVSI USES CO₂ LASER FOR SKIN TAG REMOVAL

At IVSI, ablative CO₂ laser technology is used as a surgical cutting and ablation tool for precise removal of skin tags and fibroepithelial polyps when appropriate.

Advantages include:
• Minimal to no bleeding during and after the procedure
• Improved hemostasis, especially for larger or inflamed lesions
• Precise evaporation of the lesion base, reducing regrowth risk
• Reduced post-procedure discomfort
• Controlled tissue removal with minimal impact on surrounding skin

This approach is particularly useful for the face, eyelids, neck, axilla, and other cosmetically or functionally sensitive areas.

ANESTHESIA & PATIENT COMFORT

• Small skin tags often do not require injectable anesthesia
• For sensitive areas (face, eyelids), topical numbing cream is typically applied ~45 minutes prior
• For areas such as the neck, underarms, or upper trunk, anesthesia may not be required
• Sensation is commonly described as brief, mild stinging

Use of topical anesthesia is always an option and is decided individually.

INDIVIDUALIZED METHOD SELECTION

Not every skin tag is treated the same way. Removal method is selected based on:
• Lesion size and thickness
• Presence of inflammation or bleeding
• Anatomic location
• Diagnostic certainty
• Medical vs. cosmetic intent

This individualized approach supports safe removal, accurate diagnosis when needed, and predictable healing.

POST-PROCEDURE CARE & FOLLOW-UP

Post-treatment care depends on the method used and may include:
• Local wound care instructions
• Temporary avoidance of friction
• Monitoring for healing or recurrence

Most patients return to normal activities the same day.

Explore our Skin Surgery & CO₂ Laser Procedures for related treatments.

SCHEDULE AN EVALUATION

If you have skin tags that are inflamed, bleeding, enlarging, or cosmetically concerning:

📞 Call (847) 518-9999

MEDICAL DISCLAIMER

This information is provided for educational purposes only and does not replace individualized medical evaluation. Treatment recommendations depend on clinical findings, diagnostic requirements, and patient-specific factors.