A 45-year-old man presented with a large skin growth on his back. The growth had been gradually enlarging since he first noticed it four years earlier. He had multiple similar, but smaller, growths around his eyes, neck, and upper back. His medical history included morbid obesity, hypertension, and recurrent gout.

Physical examination confirmed a pedunculated growth below his right scapula. The cauliflower dome was 3 cm in diameter, supported on a 1-cm stalk (Figure 1).

Question

Based on the patient's history and physical examination findings, which one of the following is the most likely diagnosis?

• A. Dermatofibroma.

• B. Dermatosis papulosa nigra.

• C. Fibroepithelial polyp.

• D. Seborrheic keratosis.

Discussion

The answer is C: fibroepithelial polyp. Also known as acrochordon or common skin tag, fibroepithelial polyp is a benign skin lesion of mesenchymal and ectodermal origin. Fibroepithelial polyps are often seen during routine physical examination as small, slightly discolored, papillomatous lesions, often in skin creases and areas exposed to friction. Rarely, large (greater than 5 mm), pedunculated polyps can be seen on the trunk.¹