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Enlarging growth alarms a young woman

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Enlarging growth alarms a young woman

Colette L. Caputo, MCMS, PA-C

The author practices at A Center for Dermatology in Pompano Beach, Fla. She has indicated no relationships to disclose relating to the content of this article. Joe Monroe practices in the dermatology department of the Warren Clinic, Tulsa, Okla, and is the founder and president of the Society of Dermatology Physician Assistants.

23-year-old African-American woman presents to the dermatology office with a growth on the right side of her groin area (see Figure 1). She claims that the lesion first appeared many years ago as a small, fleshy tag but that it has enlarged rapidly over the past several years. She reports only minimal irritation but expresses significant concern over its enlarged size. The patient is in good health with no history of a serious skin condition, malignancy, or underlying systemic illness.

Physical examination reveals a 5.535-cm fleshy, skin-toned, pedunculated, baglike tumor on her right inguinal area. The patient otherwise is a well-appearing, albeit overweight, African-American woman. There is no tenderness on palpation of the groin, and she has no signs of infection.

The most likely diagnosis is
• A lipoma
• An acrochordon or skin tag
• A cutaneous neurofibroma
• A keloid

Dicussion

The correct answer is an acrochordon or skin tag. Other terms used for this type of growth are fibroepithelial polyp, soft fibroma, and cutaneous papilloma. An acrochordon is a benign epidermal neoplasm that initially manifests as a 2- to 3-mm fleshy, pedunculated papule. Older patients frequently have a greater number of these lesions, which can grow to 5 cm in diameter or larger. Located in the axillae, on the neck, in the inguinal area, and in other intertriginous areas, acrochordons commonly develop on overweight persons. Hormonal imbalances, underlying systemic illnesses such as diabetes, genetic predisposition, and friction-induced growth stimuli can cause these lesions to develop. Acrochordons are removed by scissor excision, and no anesthesia is needed. However, patients who have a large acrochordon may need a local anesthetic administered before the procedure. In these patients, electrodesiccation should be performed after the scissor excision.

A lipoma is a benign subcutaneous tumor composed of fat cells encapsulated by a thin, fibrous sheath. Lipomas can appear anywhere but most frequently are seen on the upper body. The only treatment necessary is a biopsy to rule out underlying malignancy.

Solitary cutaneous neurofibromas are benign, soft, flesh-colored papules, nodules, or tumors and are sessile or pedunculated. Applying direct pressure to the lesion elicits a pathognomonic sign called buttonholing. Solitary neurofibromas are not clinically significant, but a cluster of these lesions could be a sign of neurofibromatosis, an autosomal dominant, multisystemic disorder.

Keloids are abnormalities of fibrous tissue resulting from trauma to the skin. Some ethnic groups, such as African-Americans and Hispanics, are genetically predisposed to develop these lesions. Keloids are raised, hypertrophic, firm, fixed papules, nodules, or ill-defined plaques with a distinct smooth surface that is often described as “rubbery.” The most commonly affected sites are the earlobes, chest, scalp, and areas with high skin tension. Surgical excision is not done because it may increase the risk of recurrence at the healing site.

Treatment This patient elected to have the large acrochordon removed. A local anesthetic was administered, followed by a simple scissor excision. At the 2-week follow-up visit, the patient presented with a well-healed, hyperpigmented macule.