Are Skin Tags Malignant?
No, skin tags (acrochordons) are benign skin tumors and are not malignant. 1, 2
Nature of Skin Tags
Skin tags are exceedingly common benign skin lesions consisting of skin projecting from the surrounding skin, typically occurring on the eyelids, neck, and axillae. 2, 3
These are fibroepithelial polyps with no malignant potential in their natural state. 1
Critical Clinical Caveat: Rule Out Mimics
While skin tags themselves are benign, there is an important diagnostic pitfall to avoid:
In patients with basal cell nevus syndrome (Gorlin syndrome), basal cell carcinomas can clinically resemble acrochordons. 4
Biopsy of acrochordon-like growths is recommended in patients with known basal cell nevus syndrome to rule out basal cell carcinoma masquerading as a benign skin tag. 4
Special Consideration in Pediatric Patients
In children presenting with five or more acrochordons, consider Birt-Hogg-Dubé syndrome, which is associated with bilateral multifocal renal tumors and multiple pulmonary cysts. 5
Refer to clinical genetics when a child has ≥5 acrochordons or additional features of Birt-Hogg-Dubé syndrome (facial fibrofolliculomas, peripheral fibromas, or trichodiscomas). 5
Clinical Significance Beyond Malignancy
Although not malignant, skin tags serve as important clinical markers:
Patients with acrochordons have significantly higher rates of metabolic syndrome components, including elevated fasting plasma glucose, BMI, insulin resistance, total cholesterol, LDL cholesterol, and triglycerides. 1
Multiple skin tags are independently associated with acanthosis nigricans, obesity, diabetes mellitus, and dyslipidemia. 6, 3
Patients with skin tags may benefit from screening for metabolic abnormalities and lifestyle interventions including weight reduction and dietary modifications. 3
Bottom Line for Clinical Practice
Reassure patients that skin tags are benign, but use their presence as a clinical prompt to screen for metabolic syndrome, especially in patients with multiple lesions. The only exception requiring biopsy is in patients with basal cell nevus syndrome or children with multiple lesions suggesting genetic syndromes.