Treatment of Skin Tags
Skin tags should be removed by simple snip excision with scissors, which can be performed with or without local anesthesia depending on size and patient preference.
Primary Treatment Options
Snip Excision (First-Line)
- Snip excision with micro-scissors and micro-forceps is the most straightforward and effective method for removing skin tags 1
- For small, pedunculated lesions, cutting the pedicle with a single move is sufficient 1
- Ethyl chloride spray can be used as topical anesthesia immediately before excision, providing a painless procedure that patients find more comfortable than conventional techniques 1
- Local anesthetic infiltration can be used for larger or multiple lesions, though this adds discomfort from the injection itself 1
Cryotherapy
- Cryotherapy is an acceptable alternative treatment method for skin tags 2
- This approach is particularly useful for patients who prefer non-surgical options 2
Electrodesiccation
- Electrodesiccation can effectively treat skin tags, especially when multiple lesions require treatment 2
Novel Mechanical Device Option
Pressure-Based Removal Device
- A flat adhesive patch device that applies pressure to the base of skin tags can achieve removal within 3-6 days 3
- Success rates are highest (90%) for lesions up to 1mm at the base, and 76% for lesions up to 2mm 3
- The device works by decreasing blood flow to the skin tag; successful outcome depends on achieving blood flow reduction immediately after application and at 2-3 days 3
- Discomfort is minimal throughout the procedure, and cosmetic outcomes are excellent 3
- This method is best suited for small skin tags on the neck, upper torso, and axillae 3
Important Clinical Considerations
Pre-Treatment Assessment
- While most skin tags are benign, occasionally they may contain skin cancers 4
- Dermoscopy should be performed to assess for atypical features before removal 4
- Look for uniform pigmentation patterns, dots, and coiled vessels which indicate benign lesions 4
Post-Procedure Care
- After snip excision, minimal wound care is typically required 1
- The cosmetic outcome is generally excellent with proper technique 3
Common Pitfalls to Avoid
- Avoid infiltrating local anesthesia into every single skin tag when treating multiple lesions - this causes unnecessary pain and time; consider ethyl chloride spray or simple snip excision without anesthesia for small tags 1
- Do not use the mechanical pressure device for skin tags larger than 2mm at the base, as success rates drop significantly 3
- Always assess for atypical features before assuming a lesion is a benign skin tag, as malignancy can occasionally occur 4