Jasminder and Harpreet Parmar ask if they can have a quick word with Parveen about a lump under Harpreet’s arm.

In the consultation room Harpreet shows Parveen a small skin growth towards the rear of his armpit. He says that it isn’t painful, but sometimes catches on his clothes. The skin appears soft in texture and is not discoloured. Parveen tells Harpreet he should get it checked out by the GP, just in case, but says she doesn’t think there is anything to worry about.

EXPLANATION

The lump on Harpreet’s underarm is in all likelihood an acrochordon, more commonly known as a skin tag. These harmless growths are particularly common in older people and tend to occur on areas of skin that are liable to friction, either from a fold of skin or clothing. Given Harpreet’s comment that the lump sometimes catches on his clothes, he might want to consider having the skin tag taken off. This is a simple procedure, akin to having a wart removed, but is considered cosmetic surgery so is not usually available on the NHS. If Harpreet is reluctant to seek out a healthcare professional who is prepared to perform the procedure on a private basis, he could wait to see if the skin tag falls off without any intervention, which can happen if the tissue dies because the blood supply becomes compromised.

The bigger picture

Other possible diagnoses include a wart or – as Jasminder has speculated – skin cancer. However, the surface of a wart usually appears rough and hard due to the excess keratin that accumulates in the skin, and the condition is considerably more common in children and teenagers than in people of Harpreet’s age. Warts can spread very quickly too, so the fact that Harpreet’s growth hasn’t changed in months indicates that something else is at play. Similarly, there are signs indicating that the skin growth is not cancerous, as both basal and squamous cell skin cancers tend to occur on exposed areas of the body e.g. face, ears and hands. Basal cell carcinomas are usually red or pink in colour and shiny in appearance (although they can look like red scaly patches) and they can crust or bleed. Squamous cell carcinomas are often tender, bleed easily and are usually pink with hard or scaly skin on the surface.

Extend your learning

• To get an idea of what skin tags look like, go to www.channel4embarrassingillnesses.com/conditions/skin-tags/

• Some skin tags can be removed by the patient. See “removing skin tags” at  www.nhs.uk/conditions/skin-tags/pages/introduction.aspx

Q: What methods – and under what circumstances – would you recommend for a patient who wants to remove his/her own skin tag?

A: Small skin tags with a narrow base can be removed by strangling the blood supply using dental floss or cotton to tie off the base, or by using sterile scissors to cut it off. These methods are not suitable for large skin tags, which may bleed profusely.