Tagged by a Masquerader: Two Cases of Carcinoma Clinically Presenting as Skin Tags

Summary: Skin tags are fleshy cutaneous growths that commonly appear in the later decades of life. These lesions are benign in nature, however various cutaneous malignancies may masquerade as a skin tag, thus presenting a potential diagnostic pitfall. Here we present two rare cases of malignancy initially presenting as skin tags. Case 1: An 82-year-old man with no prior history of skin cancer presented with an 8 mm pink irritated pedunculated papule on the right lateral neck that had been growing over the previous several months. Shave biopsy revealed a pedunculated tumor characterized by endophytic lobules of squamous epithelium harboring keratinocytes with large, atypical nuclei, high nuclear to cytoplasmic ratio, hyperchromasia, prominent nucleoli, and atypical mitotic figures. A diagnosis of SCCIS was made and the lesion was treated with curettage. Case 2: An 89-year-old man presented with a pedunculated erythematous excoriated lesion (length 2.2cm) on the right axilla that appeared 4 years ago and had been increasing in size. Histology revealed lobules of atypical basaloid cells with mitoses, peripheral palisading, and retraction from mucinous stroma consistent with BCC. The lesion was excised surgically. These cases highlight the need for histopathologic evaluation of larger skin tags to exclude malignancy.