Removal of Perianal Skin Tags (External Hemorrhoidal Skin Tags)

CHAPTER 108 Removal of Perianal Skin Tags (External Hemorrhoidal Skin Tags)



James A. Surrell


Perianal skin tags represent a stretching and enlargement of the normal perianal skin (Fig. 108-1). As such, they are not true external hemorrhoids. Perianal skin tags are believed to occur as a result of large external hemorrhoids that have receded. A previously thrombosed external hemorrhoid may also leave redundant skin after resolving. Patients most often seek treatment for them when they begin to interfere with anal hygiene. It is important to note that perianal skin tags do not cause pain, bleeding, or itching. If these symptoms are present, then another source must be sought as the cause of these symptoms.


image

Figure 108-1 Large perianal tag.



Indications



• Large perianal skin tags limiting anal hygiene

• Perianal skin tags that annoy the patient or are symptomatic (e.g., pruritus)

NOTE: The only time anal skin tags cause itching is when the patient is doing excessive perianal cleansing, thereby irritating the skin tag and the surrounding perianal tissues.


Generally, a conservative approach to the management of perianal skin tags is recommended because the vast majority of these benign lesions are asymptomatic. If the patient is bothered by pruritus, try local measures first. (See patient education form available online at www.expertconsult.com.)



Contraindications



• If the patient with perianal skin tags complains of pain, bleeding, or itching, then another source for these symptoms must be sought. Skin tag excision will not relieve these symptoms. Even when the patient complains of pruritus “from the tag,” be sure he or she is following proper hygiene practices noted in the aforementioned patient education handout because the tag itself may not be the cause of symptoms.

• If the perianal skin tags have a fleshy, edematous appearance, a diagnosis of anal Crohn’s disease must be strongly considered. Nearly all patients with anal Crohn’s disease will develop fleshy, edematous skin tags and have associated signs and symptoms of pain, discharge, bleeding, and atypical anal fissures (see Chapter 96, Anal Fissure and Lateral Sphincterotomy and Anal Fistula). Excision of perianal skin tags in Crohn’s disease may lead to significant morbidity because of the creation of an indolent, nonhealing wound.


Equipment



• 2% lidocaine with epinephrine, 3 to 5 mL

• 25-gauge, image-inch to 30-gauge, image-inch needle

• 4 × 4 gauze pads

• Hemostat, straight not curved

• Pickups

• No. 10 or no. 15 blade or sharp tissue scissors (alternatively, a radiofrequency/electrocautery unit)

• Monsel’s solution (ferric subsulfate)

• Cautery unit should there be bleeding

• Absorbable suture in case of uncontrolled bleeding

• Lidocaine 5% ointment

• Feminine Peri-Pad

Because the perianal skin tags are external to the anal canal, no anal retractor is needed. Any standard surgical forceps are adequate to grasp the skin tag, which is usually removed with electrocautery. The electrocautery unit should have both coagulation and cutting capability. (See Chapter 30, Radiofrequency Surgery [Modern Electrosurgery], and Chapter 149, Loop Electrosurgical Excision Procedure for Treating Cervical Intraepithelial Neoplasia, for listings of suppliers of various modern electrosurgery units.) Alternatively, the lesion can be excised with sharp tissue scissors or a knife blade, but this will increase the likelihood of bleeding.

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May 14, 2017 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Removal of Perianal Skin Tags (External Hemorrhoidal Skin Tags)

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