What is the best method for removing a skin tag?

Best Methods for Skin Tag Removal

The most effective method for removing a skin tag is surgical excision using sterile scissors or forceps, which provides immediate and complete removal with minimal discomfort when performed correctly. 1

Understanding Skin Tags

• Skin tags (acrochordons) are benign, pedunculated skin lesions that commonly occur on the neck, axilla, and groin regions 2
• They are typically skin-colored or hyperpigmented and can vary in size from very small (1mm) to larger growths 3
• Skin tags may develop due to friction in intertriginous areas, as evidenced by cases where multiple skin tags appear in a linear pattern 4

Recommended Removal Methods

Surgical Excision

• Primary recommendation: Snip excision using sterile micro-scissors and forceps after proper preparation 1, 5
• The procedure can be performed with minimal discomfort using ethyl chloride spray as a topical anesthetic 2
• For optimal results, grasp the skin tag close to the skin with fine-tipped forceps and cut at the base with sterile scissors 1
• After removal, clean the area thoroughly with soap and water, alcohol, or an iodine scrub 1

Alternative Methods

1. Cryotherapy (Freezing)

   • Application of liquid nitrogen to freeze the skin tag 1
   • Particularly effective for smaller skin tags 1
   • May require multiple treatments for complete removal 1

2. Electrocautery

   • Uses electrical current to burn off the skin tag 1
   • Provides immediate removal and simultaneous hemostasis 1
   • Requires proper training and equipment 1

3. Chemical Cauterization

   • Using agents like trichloroacetic acid (TCA) or bichloroacetic acid (BCA) 1
   • Apply small amount only to the skin tag and allow to dry 1
   • Can be repeated weekly if necessary 1

4. Ligation Devices

   • Adhesive patch devices that apply pressure to the base of the skin tag 3
   • Most effective for skin tags up to 1mm in base diameter (90% success rate) 3
   • Takes 3-6 days for complete removal 3

Factors Affecting Method Selection

• Size of skin tag: Smaller tags (≤1mm) respond well to most methods; larger tags may require surgical excision 3
• Location: Tags in sensitive areas may benefit from methods with less discomfort 2
• Number of tags: For multiple tags, quick methods like snip excision with ethyl chloride may be more practical 2
• Patient preference: Some patients may prefer non-surgical approaches despite potentially longer treatment time 3

Precautions and Considerations

• Always ensure proper identification of the lesion before removal - if there is any doubt about whether the lesion is benign, a biopsy should be performed 1
• For lesions with unusual appearance, rapid growth, or bleeding, formal excision with histological examination is preferred 1
• Avoid application of chemicals to open wounds or lesions to prevent systemic absorption 1
• After removal, monitor the site for signs of infection or unusual healing 1
• Patients with diabetes or peripheral vascular disease should exercise extra caution and may benefit from professional removal 5

Technique for Surgical Excision

1. Clean the area thoroughly with antiseptic solution 1
2. Apply topical anesthetic if needed (ethyl chloride spray is effective and painless) 2
3. Grasp the skin tag firmly at its base with fine-tipped forceps 1
4. Using sharp, sterile scissors, cut the skin tag at its base in one clean motion 1
5. Apply pressure with sterile gauze if bleeding occurs 1
6. Clean the area again and apply antibiotic ointment if desired 1