Can Skin Tags Be Darker Than a Person's Skin?
Yes, skin tags can absolutely be darker (hyperpigmented) than a person's baseline skin color, and this is a well-recognized normal variant of these benign lesions. 1
Clinical Appearance of Skin Tags
Skin tags (acrochordons) present with variable pigmentation patterns:
- Skin tags are described as either skin-colored OR hyperpigmented, making darker coloration a recognized normal presentation 1
- These benign pedunculated lesions commonly occur in intertriginous areas including the neck, axillae, and groin regions 2, 1
- The pigmentation can range from matching the surrounding skin tone to being noticeably darker 1
Why This Matters Clinically
The key distinction is recognizing what skin tags are NOT:
- Skin tags are benign neoplasms composed of loose collagen fibers and dilated capillaries - they do not represent melanocytic lesions or malignancy 3
- Unlike melanoma or atypical moles, skin tags have a smooth surface and pedunculated (stalk-like) structure 3
- The hyperpigmentation in skin tags is a benign feature and does not follow the "ABCDE" criteria used to assess concerning melanocytic lesions 4
Important Differential Considerations
When evaluating darker pigmented lesions, distinguish skin tags from:
- Melanoma: Would show asymmetry, border irregularity, color variation, diameter >6mm, and evolution over time 4
- Seborrheic keratoses: Stuck-on appearance with waxy surface, but can also be pedunculated
- Dermatofibromas: Firm, fixed dermal nodules rather than pedunculated
Common Pitfalls to Avoid
- Do not assume all hyperpigmented pedunculated lesions require biopsy - classic skin tags with typical morphology (smooth, pedunculated, soft) can be diagnosed clinically 1
- Friction-induced skin tags may appear in linear arrangements, which is a benign pattern related to mechanical trauma rather than concerning pathology 2
- Multiple skin tags (>30) warrant screening for diabetes mellitus, as there is increased prevalence of impaired carbohydrate metabolism in these patients 5
Clinical Management
- Hyperpigmented skin tags can be safely removed using standard techniques: cryotherapy, electrodessication, or snip excision 2
- Ethyl chloride spray provides effective anesthesia for multiple lesion removal 1
- Biopsy is only indicated if the lesion lacks typical skin tag morphology or shows concerning features suggestive of malignancy 4