Giant skin tag on the labium majorum.

To the Editor:

Skin tags, or acrochordon, are one of the most common skin tumors, which are small, soft, skin-colored to drak brown, sessile and pedunculated papilloma (Choudhary, 2008). Most skin tags vary in size from 2 to 5 mm in diameter, and a few unusual giant variants can also be found in the literature (Choudhary, 2008, IIango et al., 2009, Eris Eken et al., 2014). In this study, we describe a rare case with a giant skin tag on the vulva.

A 24-year-old woman presented with a painless mass on the vulval area, which developed to large proportion over two years (Figure 1A). The lesion was asymptomatic apart from the slight discomfort to the patient due to the growth. She received a surgery to excise the huge mass completely because of the aesthetic demand. Histopathology of the specimen revealed acanthosis, loosely arranged collagen fibres (Figure 1B). Based on the clinical manifestations and histopathological features, the final diagnosis was giant skin tag of the vulva.

Fig 1

(A) Large lesion on the right vulval area. (B) Acanthosis and loosely arranged collagen fibres (hematoxylin-eosin × 40).

Skin tags are seen frequently on the neck and in the axillae, and in skin fold area, such as groin and submammary regions. Less often on the penis and labium majus (Eris Eken et al., 2014). They often increase in number and size with time, but rarely reaching a large size.

The exact pathogenesis of skin tag is currently unclear. It may be associated with obesity, some endocrine diseases, diabetes mellitus, insulin resistance, genetic predisposition, carbohydrate and lipid metabolism disorders. Pregnancy is also suspected as a risk factor. Because hormonal changes may affect the development of the lesion (Eris Eken et al., 2014). Abdou et al. reported that mast cells may participate in promoting fibrosis and facilitating the development of skin tags and attract eosinophils to cooperate in inducing more fibrosis in skin tags development (Abdou et al., 2014).

Flesh-colored dermal nevus and neurofibromatosis should be considered in the differential diagnosis of the lesions (Eris Eken et al., 2014). Some uncommon benign and malignant neoplasms, including aggressive angiomyxoma, angiomyofibroblastoma, pseudosarcomatous stromal polyp, superficial angiomyxoma, myxoid liposarcoma, embryonal rhabdomyosarcoma, myxoid smooth muscle and nerve sheath tumor, are clinically some of the lesions to be considered. At times only a biopsy can differentiate these (Orosz et al., 2005). Although cutaneous skin tags are usually harmless and asymptomatic skin growths, there have been a few reported cases associated with basal cell carcinoma (Lortscher et al., 2007). If treatment is desired, surgical excision or laser ablation is effective.