The FP recognized that the patient had a large skin tag. He offered to excise it for the patient and explained that it could be removed with a deep elliptical excision and then repaired with sutures, or that it could be shaved off and allowed to heal by secondary intention. The patient opted for the shave excision because he preferred not to have sutures.
The FP numbed the area with an injection of 1% lidocaine and epinephrine, then shaved off the growth using a DermaBlade and sent it to pathology. (See a video on how to perform a shave biopsy here.) The FP used aluminum chloride to stop the bleeding. The Pathology report came back and indicated the lesion was a fibroepithelial polyp, which is essentially a large skin tag. At a 2-week follow-up, the biopsied area was healing well.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Smith AM. Skin tags. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013: 922-925.
To learn more about the Color Atlas of Family Medicine, see: www.amazon.com/Color-Family-Medicine-Richard-Usatine/dp/0071769641/
You can now get the second edition of the Color Atlas of Family Medicine as an app by clicking on this link: usatinemedia.com