A 47-year-old man comes to the physician concerned about growths in his axilla. He has noticed these for a few years but thinks that they are growing larger and becoming uncomfortable. Recently, the growths have bled when disturbed. He has no other medical problems or concerns. Skin examination findings are shown in the image below.

There is no axillary adenopathy. The remainder of the examination is normal.
This patient's condition is most likely associated with which of the following?

Question

A 47-year-old man comes to the physician concerned about growths in his axilla. He has noticed these for a few years but thinks that they are growing larger and becoming uncomfortable. Recently, the growths have bled when disturbed. He has no other medical problems or concerns. Skin examination findings are shown in the image below.

There is no axillary adenopathy. The remainder of the examination is normal.
This patient's condition is most likely associated with which of the following?

There is no axillary adenopathy.  The remainder of the examination is normal.
This patient's condition is most likely associated with which of the following?

Quizplus · Accepted Answer

11ec193a_977c_0ef6_853d_778536c4e104_MD0002_00 This patient has skin tags (acrochordons), benign outgrowths of normal skin that appear as soft, flesh-colored, or pedunculated papules. They occur in about 25% of the population, with increased frequency in older individuals. Skin tags may be caused by increased concentrations of insulin or insulin-like growth factors and may indicate underlying insulin resistance/type 2 diabetes. They are common in the 2nd trimester of pregnancy and often regress postpartum. Patients with perianal Crohn's disease may have hypertrophic skin tags that can be confused with external hemorrhoids. Skin tags typically occur at sites of friction (eg, axillae, neck, inframammary region, and groin). They can become irritated when rubbed or caught on an object (eg, jewelry). Diagnosis is based on clinical appearance and there is usually no need for pathological evaluation of typical lesions. Treatment is not required unless they become irritated or for cosmetic reasons. Treatment options include removal by forceps, cryosurgery, and electrodessication. (Choice B) Studies have shown that skin tags are not found with increased frequency in patients with colonic polyps or gastrointestinal malignancy. (Choice C) Dermatitis herpetiformis is commonly associated with gluten-sensitive enteropathy (celiac disease). It presents with erythematous, extremely pruritic papules, vesicles, or bullae that appear bilaterally on extensor surfaces, elbows, knees, upper back, and buttocks. Dermatitis herpetiformis (Choice D) There is no known association between skin tags and HIV. Instead, severe seborrheic dermatitis is the most common dermatologic diagnosis made in HIV patients. Disseminated molluscum contagiosum is also seen with increased frequency in HIV infection. seborrheic dermatitis (Choice E) Neurofibromas are also benign skin lesions. They tend to be larger and firmer than skin tags and usually occur sporadically as solitary lesions in healthy adults. They can be pushed deeper into the skin on palpation and pressure, a finding known as the "button-hole" sign. Multiple neurofibromas should prompt consideration of neurofibromatosis. Multiple neurofibromas Educational objective: Skin tags are benign outgrowths of normal skin found in regions of the body subjected to friction, such as the neck, axillae, and inner thighs. Multiple skin tags may represent underlying insulin resistance. __________ References: Lack of association between skin tags and colon polyps in a primary care setting. (http://www.ncbi.nlm.nih.gov/pubmed/3401101) Anal skin tags in inflammatory bowel disease: new observations and a clinical review. (http://www.ncbi.nlm.nih.gov/pubmed/18452201)

A 47-Year-Old Man Comes to the Physician Concerned About Growths