Skin Tag Removal in Singapore, A Doctor’s Review of What Skin Tags Are, Why They Grow and How They Are Removed

A skin tag is a fold of normal skin wrapped around a soft core of loose connective tissue and a few tiny blood vessels. It has no roots, it does not grow into the skin, and it carries few nerve endings, which is why most people only notice one when it catches on a necklace. Tags range from a pinhead to the size of a grape and are skin-coloured or slightly darker. A tag that has twisted on its stalk can turn black overnight because the twist cuts off its blood supply and the tissue dies. The change looks alarming and is harmless.

Under the dermatoscope a true skin tag is featureless, and that absence of pattern is what confirms it. A growth that shows a pattern under the dermatoscope, such as a pigment network or branching vessels, is something else, and the growths mistaken for tags are covered below.

Pregnancy promotes skin tags, partly through weight gain and hormonal change and partly through the same insulin pathway, because insulin resistance rises in the second half of pregnancy. Tags are more common in women who develop diabetes in pregnancy. Tags that appear in pregnancy often shrink after delivery, so I usually leave them until then unless they catch or rub.

In children skin tags are uncommon, and their presence calls for a closer look. Children who develop them tend to be carrying extra weight, and the tags sit in the armpit as they do in adults. More importantly, there is a rare inherited condition, nevoid basal cell carcinoma syndrome, in which growths that resemble skin tags in a child are small basal cell carcinomas. A skin tag on a child is therefore removed and sent to the laboratory, not snipped and discarded.

The human papillomavirus (HPV), the wart virus, has been found inside skin tags in laboratory studies. The finding sounds alarming and is not. The types found are the low-risk ones, the virus is thought to play a small part in how a tag grows rather than to cause it, and skin tags do not spread from person to person or from one part of the body to another. A skin tag cannot be caught from a towel, and removing one does not cause others to appear. New tags after removal come from the same friction and insulin that produced the first ones.

Snip excision

After the stalk is numbed with local anaesthetic, the tag is cut off at its base with fine surgical scissors or a blade. Snip excision is the quickest method, gives an immediate result and requires no stitches because the base is narrow, and it is the method I use for most tags.

Cryotherapy

Liquid nitrogen, at minus 196°C, freezes the tag, which darkens and drops off over one to two weeks. Cryotherapy is useful for several very small tags and for patients who prefer to avoid an injection. The tag is not removed on the day of treatment, and because pigment cells are damaged at temperatures that other skin cells survive, freezing can leave a pale mark on darker skin. I therefore use cryotherapy selectively.

Electrocautery

A fine electrically heated tip removes the tag and coagulates the small blood vessels in its base at the same time, so bleeding is minimal. Electrocautery is well suited to tags on the eyelid margin and to larger tags with a broad base.

CO2 laser

The CO2 laser vaporises a tag with very little bleeding, because the heat seals the vessels as it removes tissue, and suits flat or broad-based tags and small tags on the face, where a neat flat mark matters most. The four methods, the price for each and what happens on the day are set out on my skin tag removal price page.

Tags on the eyelid margin are removed by cautery or snip excision after anaesthetic eye drops and a small local anaesthetic injection, with care taken to preserve the lash line. Freezing is avoided on the lid because it can leave a pale mark on the thin lid skin. Facial tags are removed by snip excision or the CO2 laser, which give an immediate result and leave a flat mark.

Tags on the neck, armpit, groin and around the anus are covered site by site on my skin tags on the neck, face, armpit and eyelid page.

A growth that is firm, pigmented, enlarging or bleeding, or that has a broad base rather than a stalk, may not be a skin tag. I examine every growth under the dermatoscope before removal, and any growth without the appearance of a simple tag is assessed in the same way as a mole, described on my mole removal in Singapore page.

The risk of a growth labelled a skin tag proving to be a skin cancer is very low, and in a large laboratory review of growths submitted as skin tags by dermatologists, none was malignant. The risk sits in the growths that were never true tags. The ones I see mistaken for tags are a mole on a stalk, the waxy brown growth of middle age called a seborrhoeic keratosis, a soft neurofibroma, a wart with its rough surface, and rarely a pearly basal cell carcinoma with fine vessels on its surface. Any growth that is firm, pigmented, enlarging, bleeding or new in a child is not removed as a tag. It is removed by shave or excision and sent to the laboratory, with results in 2 to 3 weeks.

Medically, a skin tag never has to be removed. It is removed when it catches, bleeds, rubs under a collar or a strap, sits on the eyelid or face, or simply because the patient would rather it were gone, and that is reason enough. Removal is quick, the mark usually disappears within weeks, and every tag on the face or the neck is removed in one visit for one fee.

The three situations in which I advise against immediate removal are when the growth is not clearly a tag, when it is on a child, and when a patient has dozens of new tags with no explanation, because then the more useful appointment is the blood test, and the tags can be removed afterwards.