PEDUNCULATED PAPULE ON THE LEFT AXILLA
The store-and-forward feature of teledermatology allows patient medical information (including history and visual data) obtained from one provider's location to be electronically transferred to a provider in another location (Roman & Jacob, 2015). The construct of the Teledermatology Viewpoint column is such that cases are presented in a standardized teledermatology reader format reflective of an actual teledermatology report.
TELEDERMATOLOGY READER REPORT1
Chief Complaint
Presenting for diagnosis and possible treatment.
History of Present Illness
A 44-year-old man with Type 2 diabetes and obesity presents with a lesion in the left axilla that has been enlarging in the last 2 years. The patient states he has five other similar smaller lesions located on his neck, but this lesion is specifically irritating. He has no personal history of skin cancer or any other malignancy. The patient's body mass index is 38 (normal range: 18.5-24.9). Pertinent laboratory findings include a recent hemoglobin A1C of 8.5 (indicating poor control of his diabetes).
IMAGE QUALITY ASSESSMENT
Fully satisfactory.
TELEDERMATOLOGY IMAGING READER REPORT
Two images were provided. Figure 1 shows a fleshy, soft appearing, pedunculated papule. Figure 2 (dermoscopic image) shows a fleshy, cerebriform surfaced papule with no ulceration, pigment changes, or arborizing telangiectasias.
INTERPRETATION OF IMAGES
Lesion A
Findings are consistent with giant acrochordon.
RECOMMENDATIONS
Lesion A
Reassure the patient of the benign nature of the lesion. If the patient requests to have the lesion removed because of irritation, a snip excision can be performed. After cleansing the skin with an alcohol pad and anesthetizing the base. gently elevate the lesion from the skin surface with forceps, apply aluminum chloride at the base, and allow to dry; frosting may appear on the skin. Then, using fine iris scissors, cut across the thinnest area of the stalk. Reapply aluminum chloride to the base if needed for hemostasis. Then, apply white petrolatum and an adhesive bandage. Nutritional, preventive medicine and diabetic education consults should be considered to assist the patient with weight loss and improved glycemic control.
RECOMMENDED FOLLOW-UP
Return to primary care provider for management and education.
CLINICAL PEARL
Acrochordon, commonly "known as skin tag," is a fibroepithelial polyp that usually measures between 1 and 10 mm (Alkhalili et al., 2015). Larger lesions measuring up to 42 cm have been reported (Can & Ozluk, 2020). Insulin resistance, obesity, lymphedema, and chronic inflammation are thought to play an etiologic role in the development of these lesions (Can & Ozluk, 2020). They are commonly found in the intertriginous areas of the neck, axilla, and groin, but other locations have been reported (Can & Ozluk, 2020; Garg & Baveja, 2015).
REFERENCES