{ "slug": "anus-skin-tag-is-dangerous", "question": "Are skin tags on the anus dangerous?", "shortTitle": "Are Anal Skin Tags Dangerous?", "clinicalQuestion": "In adults who have a skin tag at or around the anus, does the presence of such a tag indicate or predict malignancy, anal disease, or other serious pathology compared with people without one, and does it warrant biopsy or removal to rule out danger?", "pico": { "population": "Adults with a skin tag located at or around the anus (perianal skin)", "intervention": "Observation/diagnosis of an anus skin tag, with or without biopsy or surgical removal", "comparator": "No anal skin tag present, or watchful waiting without biopsy/removal", "outcomes": [ "Rate of malignant transformation or coexisting anal malignancy", "Association with anal fissure, hemorrhoids, or inflammatory bowel disease", "Bleeding or infection related to the tag", "Diagnostic accuracy of visual exam vs biopsy for ruling out pathology", "Recurrence after removal", "Pain or complication rate from removal" ] }, "category": "anorectal", "relatedConditions": [ "hemorrhoids", "anal-fissure", "anal-warts", "crohns-disease" ], "relatedTreatments": [], "relatedEvidence": [], "bottomLine": { "verdict": "Whether a skin tag at the anus signals something dangerous is unclear — the only studies that looked at this directly found conflicting results.", "detail": "Only two small case reports looked at this question directly. One found that cancer from a man's existing colorectal cancer had spread into a skin tag, which changed his surgical plan. The other found a perianal skin tag in an infant that looked like it could be a dangerous tumor, but biopsy showed it was a benign growth with no risk of turning cancerous. Everything else in the evidence comes from single-patient reports or from reviews about Crohn's disease and hemorrhoids, not from studies built to measure how risky an ordinary skin tag actually is.", "studyIds": [ "pmid:31560504", "pmid:27034567" ] }, "strength": { "level": "very-low", "why": "The only direct evidence is 2 small or uncontrolled studies.", "override": null }, "direction": { "level": "unclear", "why": "The studies point in different directions.", "override": null }, "counts": { "recordsRetrieved": 49, "recordsScreened": 48, "included": 22, "rcts": 1, "systematicReviews": 0, "observational": 3, "participants": 1396, "yearFrom": 1984, "yearTo": 2026, "registeredTrialsWithoutResults": 0 }, "excluded": [], "outcomes": [ { "name": "Malignant transformation or cancer found inside the tag", "status": "insufficient", "note": "One case report described an anal skin tag that turned cancerous in a young man with Crohn's disease. A separate case report found that a skin tag in a man with existing colorectal cancer contained cancer cells that had spread there from his cancer elsewhere — this was a metastasis to the tag, not cancer arising from the tag itself. A third case report described a congenital skin-tag-like growth near the anus in a baby that looked like it could be a dangerous tumor, but biopsy showed it was a benign, non-cancerous growth. These are three individual patients, not a study of how often cancer is found in skin tags.", "studyIds": [ "pmid:31560504", "pmid:27034567", "pmid:6479689" ] }, { "name": "Association with fissures, hemorrhoids, or inflammatory bowel disease", "status": "insufficient", "note": "Several reviews note that skin tags often appear alongside anal fissures, hemorrhoids, or Crohn's disease, but none of them measured how often this happens or whether having a tag predicts these conditions.", "studyIds": [ "pmid:34636364", "pmid:32077979", "pmid:20310013", "pmid:19997893", "pmid:15227686" ] }, { "name": "Bleeding or infection caused by the tag itself", "status": "not-studied", "note": "No study in this set measured how often skin tags themselves bleed or become infected.", "studyIds": [] }, { "name": "Accuracy of a visual exam versus biopsy for ruling out danger", "status": "insufficient", "note": "No study tested how reliably a doctor can rule out something serious just by looking. Case reports show appearances can mislead in both directions — a harmless growth looked like a tumor, and a cancer looked like an ordinary skin tag.", "studyIds": [ "pmid:31560504", "pmid:22639782" ] }, { "name": "Recurrence after removal", "status": "not-studied", "note": "No study followed people after skin tag removal specifically to see whether the tags come back.", "studyIds": [] }, { "name": "Pain or complications from removal", "status": "possible-harm", "note": "In one small surgical trial, removing skin tags at the same time as hemorrhoid surgery caused more pain than leaving the tags alone.", "studyIds": [ "pmid:15790202" ] } ], "benefits": [ { "text": "One case report found that a perianal skin tag in an infant looked like it could be a dangerous tumor (rhabdomyosarcoma), but biopsy identified it as a benign hamartoma with no risk of becoming cancerous — showing how tissue testing can settle the question for an individual.", "studyIds": [ "pmid:31560504" ] }, { "text": "One expert guideline statement notes that large, bothersome skin tags can be surgically removed without needing the bigger hemorrhoid surgery (hemorrhoidectomy).", "studyIds": [ "pmid:42067175" ] } ], "limitations": [ { "text": "Almost all direct evidence on skin tags and danger comes from single-patient case reports, so there is no way to know how common any risk actually is.", "studyIds": [ "pmid:31560504", "pmid:27034567", "pmid:22802557", "pmid:22639782", "pmid:18189031", "pmid:6479689" ] }, { "text": "Most of the broader studies are about Crohn's disease or hemorrhoids, not about isolated skin tags in otherwise healthy people, so they only partly answer this question.", "studyIds": [ "pmid:41464711", "pmid:26908665", "pmid:26446683", "pmid:25746229", "pmid:23044675", "pmid:20310013", "pmid:18189031", "pmid:15227686", "pmid:9194457" ] } ], "risks": [ { "text": "A man with colorectal cancer was found to have cancer cells inside what looked like an ordinary hemorrhoidal skin tag.", "studyIds": [ "pmid:27034567" ], "severity": "serious" }, { "text": "A young man with Crohn's disease had a skin tag that turned into cancer over time.", "studyIds": [ "pmid:6479689" ], "severity": "serious" }, { "text": "In people with Crohn's disease, a skin tag has sometimes turned out to be hiding a deeper problem, like a fistula or a narrowed rectum, discovered only after biopsy or surgery.", "studyIds": [ "pmid:26908665", "pmid:18189031" ], "severity": "minor" }, { "text": "Removing skin tags along with hemorrhoid surgery was linked to more pain afterward than leaving them in place.", "studyIds": [ "pmid:15790202" ], "severity": "minor" } ], "whyPeopleTryIt": [ { "text": "A new bump near the anus feels alarming, and searching online feels more private than calling a doctor." }, { "text": "Anything unusual in that area gets mentally linked to cancer, even though most such bumps are leftover skin from an old hemorrhoid or fissure." }, { "text": "Embarrassment about the location often delays an in-person exam, so people look for a quick yes-or-no answer first." } ], "keyStudies": [ "pmid:27034567", "pmid:31560504", "pmid:6479689", "pmid:15790202", "pmid:42067175", "pmid:18189031", "pmid:26908665", "pmid:20310013" ], "studies": [ { "id": "pmid:42067175", "pmid": "42067175", "doi": "10.1016/j.cgh.2026.04.008", "nctId": null, "pmcid": null, "title": "AGA Clinical Practice Update on Diagnosis and Treatment of Hemorrhoids: Expert Review", "firstAuthor": "Qureshi", "multipleAuthors": true, "journal": "Clin Gastroenterol Hepatol", "year": 2026, "design": "guideline", "n": null, "nField": "not-reported", "population": "Patients with hemorrhoids, including those with large anal skin tags", "intervention": "Removal of skin tags without a hemorrhoidectomy", "comparator": "Surgical hemorrhoidectomy", "primaryOutcome": "Whether skin tags require major surgical removal", "result": "Large skin tags can be removed without a hemorrhoidectomy if they are not associated with significant hemorrhoids", "resultDirection": "no-benefit", "quality": "very-low", "qualityWhy": "This is an expert opinion guideline based on a non-systematic review of the literature, so it carries no formal evidence rating and is not a controlled study of skin tags themselves.", "directness": "indirect", "limitations": "This is a best-practice advice statement from an expert panel, not a systematic review or trial, and the abstract states these statements 'do not carry formal ratings regarding the quality of evidence.'", "followUp": "", "plainFinding": "Skin tags often removable without major surgery", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42067175/", "sourceText": "DESCRIPTION: Hemorrhoids are a common problem. The diagnosis and treatment can be challenging. Gastroenterologists have much to offer these patients. The purpose of this American Gastroenterological Association (AGA) Clinical Practice Update Expert Review is to provide best practice advice (BPA) covering the diagnosis and treatment of hemorrhoid disease. METHODS: This expert review was commissioned and approved by the AGA Institute Clinical Practice Updates Committee (CPUC) and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership and underwent internal peer review by the CPUC and external peer review through standard procedures of Clinical Gastroenterology and Hepatology. These BPA statements were drawn from a review of the published literature and from expert opinion. Because systematic reviews were not performed, these BPA statements do not carry formal ratings regarding the quality of evidence or strength of the presented considerations. Best Practice Advice Statements BPA 1: The diagnosis and treatment of hemorrhoids is within the purview of the gastroenterologist. The diagnosis and grading of hemorrhoids is easily made by taking a history from the patient and examining the patient. Symptoms caused by hemorrhoids include bleeding, itching, discomfort, and/or prolapse. Hemorrhoids only cause significant pain when acutely thrombosed. Sharp pain on defecation is most likely anal fissure. BPA 2: Dietary and lifestyle modifications, including increasing fiber intake and avoiding straining or prolonged time on the toilet, are reasonable first-line therapies for symptomatic hemorrhoids. The use of sitz baths for symptom improvement in symptomatic hemorrhoids is often advised, but scientific data is limited. BPA 3: Topical treatments, including anesthetics, astringents (witch hazel), corticosteroids, and vasoactive agents, can be considered for treatment of symptomatic hemorrhoids, but there is little data to support efficacy. Topical steroids should not be used for more than 2 weeks at a time. BPA 4: Anoscopy should be performed, whenever possible, on every new patient with suspected hemorrhoids, prior to treatment, to ensure accurate diagnosis. BPA 5: Both hemorrhoid banding and infrared coagulation are safe, effective, and easy to perform in the office setting. Infrared coagulation and rubber band ligation have similar benefits in the short term. Rubber band ligation has longer-term benefits for treatment of prolapsing hemorrhoids and recurrent bleeding. Hemorrhoid banding or infrared coagulation should be employed prior to surgical hemorrhoidectomy for grades 1 to 3 hemorrhoids. BPA 6: As part of informed consent for hemorrhoid therapies, the patient must be made aware of the small possibility of pelvic sepsis as a complication. Patients should be counseled about the risk and instructed to present to the emergency department immediately for evaluation, if indicated. BPA 7: In patients with active Crohn's disease or ulcerative colitis, hemorrhoid disease management should be delayed until complete remission is achieved. BPA 8: Hemorrhoids occur in up to two-thirds of women during pregnancy. Treatment should generally involve conservative management, including fiber, treatment of constipation, and topical ointments. If symptoms persist postpartum, or if a woman is planning further pregnancies, standard treatment such as banding or infrared coagulation can be considered. BPA 9: Acute thrombosed hemorrhoids are often extremely painful. They are best treated surgically with incision and drainage. BPA 10: Consultation with a surgeon should be offered to patients with grade 3 internal hemorrhoids who fail banding procedures or have associated external hemorrhoids. Large skin tags can be removed without a hemorrhoidectomy if they are not associated with significant hemorrhoids. Grade 4 internal hemorrhoids require surgical hemorrhoidectomy. BPA 11: Patients with cirrhosis and hemorrhoids should be carefully examined so as not to confuse hemorrhoids with rectal varices. Hemorrhoids in patients with cirrhosis can be treated with banding or infrared coagulation. In patients with significant coagulopathy, infrared coagulation is preferred to banding. Concomitant portal hypertension should not alter this approach. For most clinicians, significant coagulopathy means a platelet count of less than 50,000 per microliter or international normalized ratio greater than 2.0. The presence of concomitant portal hypertension should not alter this approach.", "provenance": [ { "field": "population", "quote": "Large skin tags can be removed without a hemorrhoidectomy if they are not associated with significant hemorrhoids." }, { "field": "intervention", "quote": "Large skin tags can be removed without a hemorrhoidectomy" }, { "field": "comparator", "quote": "without a hemorrhoidectomy" }, { "field": "primaryOutcome", "quote": "Large skin tags can be removed without a hemorrhoidectomy if they are not associated with significant hemorrhoids." }, { "field": "result", "quote": "Large skin tags can be removed without a hemorrhoidectomy if they are not associated with significant hemorrhoids." }, { "field": "qualityWhy", "quote": "these BPA statements do not carry formal ratings regarding the quality of evidence or strength of the presented considerations" } ] }, { "id": "pmid:41464711", "pmid": "41464711", "doi": "10.3390/jcm14248811", "nctId": null, "pmcid": "PMC12733978", "title": "Non-Fistulizing Perianal Disease in Crohn's Disease: Clinical Significance, Pathogenesis, and Management Strategies", "firstAuthor": "Abreu Marques", "multipleAuthors": true, "journal": "J Clin Med", "year": 2025, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "People with Crohn's disease who develop perianal skin tags and other non-fistulizing lesions", "intervention": "A narrative review of the literature on non-fistulizing perianal Crohn's disease, including skin tags, fissures, ulcers and strictures", "comparator": "", "primaryOutcome": "Whether these perianal lesions (including skin tags) are linked to a worse disease course or to anal cancer", "result": "The review states the link between non-fistulizing perianal Crohn's lesions and anal cancer is uncertain, while deep ulcers and strictures (not skin tags specifically) were associated with a less favorable disease course", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is a narrative review without a systematic search or pooled data, so it summarizes existing literature rather than providing strong direct evidence.", "directness": "indirect", "limitations": "Narrative (non-systematic) review focused on Crohn's disease patients specifically, without standardized classification of lesions or quantitative analysis.", "followUp": "", "plainFinding": "Cancer link uncertain, not clearly dangerous.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41464711/", "sourceText": "Background: Perianal involvement is a well-recognized manifestation of Crohn's disease (CD). However, non-fistulizing perianal phenotypes remain underrecognized despite their significance in clinical practice and impact on patients' quality of life. Methods: A narrative review of the literature up to September 2025 was conducted, with an emphasis on studies that differentiated between non-fistulizing and fistulizing lesions. Results: During the CD course, approximately 45% of patients with CD develop non-fistulizing perianal manifestations, including fissures, ulcers, strictures, and skin tags. These lesions may resolve spontaneously with the ongoing CD therapy or additional conservative measures, but some evolve into more complex conditions, with challenging management. Deep ulcers and strictures appear to be associated with a less favorable disease course. While biologic therapy has altered the overall course of CD, its role in treating non-fistulizing perianal Crohn's disease (PCD) requires further understanding. Surgical intervention, which carries an increased risk of complications, is typically reserved for individuals who are refractory to other treatments. The potential association between non-fistulizing PCD and anal cancer remains uncertain. Conclusions: Non-fistulizing PCD is a clinically significant condition that requires early recognition and individualized management. Prospective studies with standardized lesion classification, careful monitoring of disease course, and evaluation of biologic therapies and biomarkers are needed to develop evidence-based strategies and improve patient outcomes on non-fistulizing PCD.", "provenance": [ { "field": "population", "quote": "During the CD course, approximately 45% of patients with CD develop non-fistulizing perianal manifestations, including fissures, ulcers, strictures, and skin tags." }, { "field": "intervention", "quote": "A narrative review of the literature up to September 2025 was conducted, with an emphasis on studies that differentiated between non-fistulizing and fistulizing lesions." }, { "field": "primaryOutcome", "quote": "The potential association between non-fistulizing PCD and anal cancer remains uncertain." }, { "field": "result", "quote": "The potential association between non-fistulizing PCD and anal cancer remains uncertain." }, { "field": "result", "quote": "Deep ulcers and strictures appear to be associated with a less favorable disease course." } ] }, { "id": "pmid:38580520", "pmid": "38580520", "doi": "10.1016/j.jviscsurg.2024.03.005", "nctId": null, "pmcid": null, "title": "Hemorrhoidal disease: Epidemiological study and analysis of predictive factors for surgical management", "firstAuthor": "Fathallah", "multipleAuthors": true, "journal": "J Visc Surg", "year": 2024, "design": "prospective-cohort", "n": 472, "nField": "reported", "population": "adults with hemorrhoidal disease seen in a French clinic", "intervention": "surgical treatment for hemorrhoids", "comparator": "medical or instrumental (non-surgical) treatment for hemorrhoids", "primaryOutcome": "change in bleeding and prolapse symptom scores and patient satisfaction after treatment", "result": "Surgery produced a bigger drop in bleeding and prolapse scores and more patients were very satisfied (73% vs 54%) than with medical or instrumental treatment", "resultDirection": "benefit", "quality": "low", "qualityWhy": "it's a single-center observational study without randomization, so patients weren't assigned by chance to surgery or other treatment, making it hard to know if surgery itself caused the difference.", "directness": "indirect", "limitations": "Single-center, non-randomized comparison between treatment groups; satisfaction is a subjective measure; abstract does not describe how skin tags themselves relate to any danger or complication, only that they predict likelihood of surgery being chosen.", "followUp": "", "plainFinding": "Skin tags linked to more surgery, not danger.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38580520/", "sourceText": "INTRODUCTION: There are very few French studies on hemorrhoidal disease and its management. PATIENTS AND METHODS: Prospective single-center study from July to December 2021 including 472 patients. RESULTS: Bleeding, prolapse and pain were the main reasons for consultation. Treatment modalities were medical (44%),±instrumental (72%), and surgical (17%). After treatment, the bleeding score and prolapse score decreased significantly (P=0.002 and P≤0.0001, respectively), but improvement was more marked in the surgery group with a better rate of \"very good satisfaction\" (73% vs. 54%, P=0.003). Factors associated with likelihood of surgical treatment were: age>44years, hypertrophic perianal skin tags, high scores (Bristol>5, bleeding>5, prolapse>2), severe impact on quality of life, smoking and reading during bowel movements. We have developed an online application, which aims to assess the risk of requiring hemorrhoidal surgery. CONCLUSION: Less than 20% of patients who present with hemorrhoidal disease require surgical treatment, but it is associated with better effectiveness despite more complex postoperative consequences that sometimes motivate patient refusal. We have highlighted factors associated with surgical management, which can guide the practitioner in their therapeutic choices.", "provenance": [ { "field": "n", "quote": "472 patients" }, { "field": "population", "quote": "Prospective single-center study from July to December 2021 including 472 patients." }, { "field": "intervention", "quote": "Treatment modalities were medical (44%),±instrumental (72%), and surgical (17%)." }, { "field": "comparator", "quote": "Treatment modalities were medical (44%),±instrumental (72%), and surgical (17%)." }, { "field": "primaryOutcome", "quote": "the bleeding score and prolapse score decreased significantly" }, { "field": "result", "quote": "improvement was more marked in the surgery group with a better rate of \"very good satisfaction\" (73% vs. 54%, P=0.003)" }, { "field": "result", "quote": "Factors associated with likelihood of surgical treatment were: age>44years, hypertrophic perianal skin tags, high scores (Bristol>5, bleeding>5, prolapse>2), severe impact on quality of life, smoking and reading during bowel movements." } ] }, { "id": "pmid:34636364", "pmid": "34636364", "doi": "10.1097/MOG.0000000000000795", "nctId": null, "pmcid": null, "title": "'Bumps down under:' hemorrhoids, skin tags and all things perianal", "firstAuthor": "Alvarez-Downing", "multipleAuthors": true, "journal": "Curr Opin Gastroenterol", "year": 2022, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with common perianal conditions like hemorrhoids, anal fissure and anal fistula", "intervention": "various treatments for hemorrhoids, anal fissure and anal fistula", "comparator": "", "primaryOutcome": "", "result": "The abstract does not report any findings about skin tags being dangerous; it reviews treatment advances for hemorrhoids, anal fissure and anal fistula", "resultDirection": "unclear", "quality": "low", "qualityWhy": "It is a narrative review of treatment techniques, not a study measuring risk, and it never actually discusses skin tags despite the title.", "directness": "indirect", "limitations": "No data on skin tags themselves; focuses on surgical and medical treatment of other perianal diseases.", "followUp": "", "plainFinding": "Doesn't address skin tag danger.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34636364/", "sourceText": "PURPOSE OF REVIEW: There continues to be a concentrated effort to improve treatment options readily available for some of the most common perianal diseases: hemorrhoids, anal fissure and anal fistula. The emphasis remains on therapies that definitively address the underlying pathology yet minimize pain and risk of incontinence, have a short recovery period, and are cost-effective. In this analysis, recent developments in the literature are reviewed. RECENT FINDINGS: Treatment of early stage hemorrhoidal disease remains the same. For grades II-IV disease, hemorrhoidal vessel ligation/obliteration with laser or bipolar energy are reported. For more advanced diseases, modifying the technique for hemorrhoidectomy to improve postoperative complications and pain is described. For anal fissure, a stepwise method continues to be the mainstay of treatment (initiating with vasodilators, followed by botox, and ultimately sphincterotomy), which decreases the risk of incontinence with proper patient selection and technique. Management of anal fistula continues to be challenging, balancing cure vs. risk of harm. Recent developments include modifications to ligation of intersphincteric fistula tract procedure and use of laser to obliterate the tract. SUMMARY: Advancements in managing benign anorectal disease are ongoing. Several reports are novel, whereas others involve enhancing well-established treatment options by either operative technique or patient selection.", "provenance": [ { "field": "population", "quote": "some of the most common perianal diseases: hemorrhoids, anal fissure and anal fistula" }, { "field": "intervention", "quote": "Treatment of early stage hemorrhoidal disease remains the same. For grades II-IV disease, hemorrhoidal vessel ligation/obliteration with laser or bipolar energy are reported." }, { "field": "result", "quote": "Advancements in managing benign anorectal disease are ongoing. Several reports are novel, whereas others involve enhancing well-established treatment options by either operative technique or patient selection." } ] }, { "id": "pmid:33216045", "pmid": "33216045", "doi": "10.3233/NPM-200523", "nctId": null, "pmcid": null, "title": "Anal skin tag - An unusual presenting feature of food protein-induced allergic proctocolitis in a neonate", "firstAuthor": "Zaki", "multipleAuthors": true, "journal": "J Neonatal Perinatal Med", "year": 2021, "design": "case-series", "n": 1, "nField": "reported", "population": "a 26-day-old breastfed baby with blood in stools and anal skin tags", "intervention": "amino acid formula (after elimination diet and hydrolyzed formula failed)", "comparator": "no comparator (single case)", "primaryOutcome": "recovery from blood in stools / allergic proctocolitis", "result": "complete recovery after starting amino acid formula", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single case report, so it cannot show whether skin tags themselves are dangerous or reliably predict any condition.", "directness": "indirect", "limitations": "Single case report; cannot establish general risk or causation; no control group.", "followUp": "", "plainFinding": "Skin tag linked to treatable food allergy, not danger.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33216045/", "sourceText": "BACKGROUND: Anal skin tags are commonly seen with anal fissures, haemorrhoids, inflammatory bowel disease and their association have been extensively studied. However the presence of anal skin tag in food protein-induced allergic proctocolitis has rarely been reported in literature. We report a neonate with food protein-induced allergic proctocolitis who presented with blood in stool and anal skin tag. CASE DESCRIPTION: A 26-day-old baby presented with history of passing intermittent blood in stools for two days. The baby was exclusively breast-fed and was well-appearing with no failure to thrive. Two anal skin tags were present but there was no evidence of anal fissures or haemorrhoids. The biopsy of anal skin tag showed fibroepithelial polyp. Colonoscopy was suggestive of food protein-induced allergic proctocolitis. In view of poor response to elimination diet in the mother and extensively hydrolysed formula, the baby was started on amino acid formula with complete recovery. CONCLUSION: Through this case we wish to highlight that clinicians should consider food protein-induced allergic proctocolitis in their differential diagnosis in a neonate presenting with blood in stools and anal skin tag.", "provenance": [ { "field": "population", "quote": "A 26-day-old baby presented with history of passing intermittent blood in stools for two days." }, { "field": "intervention", "quote": "the baby was started on amino acid formula with complete recovery" }, { "field": "comparator", "quote": "poor response to elimination diet in the mother and extensively hydrolysed formula" }, { "field": "primaryOutcome", "quote": "complete recovery" }, { "field": "result", "quote": "the baby was started on amino acid formula with complete recovery" }, { "field": "n", "quote": "A 26-day-old baby presented" } ] }, { "id": "pmid:32077979", "pmid": "32077979", "doi": "10.1007/s00105-020-04553-y", "nctId": null, "pmcid": null, "title": "[Differential diagnosis of hemorrhoidal disease]", "firstAuthor": "Herold", "multipleAuthors": false, "journal": "Hautarzt", "year": 2020, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "adults with hemorrhoid-like anal symptoms", "intervention": "knowing the differential diagnoses of hemorrhoids (including skin tags)", "comparator": "other anal conditions such as anal fissure, prolapse, condylomata, and anal cancer", "primaryOutcome": "distinguishing hemorrhoids and related phenotypes (including skin tags) from other anal diseases", "result": "The abstract only lists skin tags as one of several phenotype findings to be differentiated from hemorrhoids; it gives no data on whether skin tags themselves are dangerous.", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a narrative review that only categorizes differential diagnoses and presents no original data or risk assessment for skin tags.", "directness": "indirect", "limitations": "The abstract does not address the safety or malignant potential of skin tags specifically; it only places them in a list of conditions to distinguish from hemorrhoids.", "followUp": "", "plainFinding": "Skin tags listed only as diagnosis category", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/32077979/", "sourceText": "Hemorrhoidal disease is one of the most common illnesses in industrialized nations. Up to 70% of adults suffer from the disease once in their lifetime. This underlines the necessity and importance of knowing about the differential diagnosis of hemorrhoids. One can differentiate between differential diagnoses of symptoms (bleeding, pain, itching, tumor) and differential diagnoses of the phenotype findings (anal prolapse, mucosal prolapse and rectal prolapse, skin tags, hypertrophied anal papillae, condylomata acuminata, anal fissure, perianal venous thrombosis, anal cancer).", "provenance": [ { "field": "population", "quote": "Up to 70% of adults suffer from the disease once in their lifetime." }, { "field": "intervention", "quote": "knowing about the differential diagnosis of hemorrhoids" }, { "field": "primaryOutcome", "quote": "One can differentiate between differential diagnoses of symptoms (bleeding, pain, itching, tumor) and differential diagnoses of the phenotype findings (anal prolapse, mucosal prolapse and rectal prolapse, skin tags, hypertrophied anal papillae, condylomata acuminata, anal fissure, perianal venous thrombosis, anal cancer)." }, { "field": "comparator", "quote": "anal prolapse, mucosal prolapse and rectal prolapse, skin tags, hypertrophied anal papillae, condylomata acuminata, anal fissure, perianal venous thrombosis, anal cancer" }, { "field": "result", "quote": "differential diagnoses of the phenotype findings (anal prolapse, mucosal prolapse and rectal prolapse, skin tags, hypertrophied anal papillae, condylomata acuminata, anal fissure, perianal venous thrombosis, anal cancer)" } ] }, { "id": "pmid:31560504", "pmid": "31560504", "doi": "10.5546/aap.2019.eng.e519", "nctId": null, "pmcid": null, "title": "Rhabdomyomatous mesenchymal hamartoma developed at an unexpected location", "firstAuthor": "Sayan", "multipleAuthors": true, "journal": "Arch Argent Pediatr", "year": 2019, "design": "case-series", "n": 1, "nField": "reported", "population": "a 38-day-old girl with a skin tag near the anus", "intervention": "biopsy and microscopic examination of the skin tag", "comparator": "", "primaryOutcome": "whether the lesion was a dangerous or cancerous growth", "result": "the lesion was a benign hamartoma that does not carry risk of recurrence or turning cancerous, but it can look like a dangerous tumor (rhabdomyosarcoma) so tissue diagnosis is needed", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a report of just one baby, so it cannot show how common or risky these skin tags usually are", "directness": "direct", "limitations": "single case report with no comparison group, so findings may not generalize to other children with perianal skin tags", "followUp": "", "plainFinding": "This specific tag was harmless, not cancer", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/31560504/", "sourceText": "Rhabdomyomatous mesenchymal hamartoma is a rare dermal lesion which was first described in 1986 as \"striated muscle hamartoma\". It usually develops in the head and neck region of newborns. We report a 38-day-old girl with a congenital skin tag in the perianal region. Physical examination did not reveal any congenital abnormalities or other dermal lesions. Histopathological examination showed a hamartoma with disorganized skeletal muscle fibers. The differential diagnosis includes skin tag, accessory tragus and soft fibroma. Rhabdomyomatous mesenchymal hamartoma differs from the listed lesions with its striated muscle component. Since it does not carry the risk of recurrence and malignant transformation, it is not very important to distinguish it from these lesions. However, a correct diagnosis is important because approximately one third of the cases are associated with congenital anomalies. Also, histopathological diagnosis should be made in children with perianal localization due to similar clinical manifestation of rhabdomyosarcoma.", "provenance": [ { "field": "n", "quote": "We report a 38-day-old girl with a congenital skin tag in the perianal region." }, { "field": "population", "quote": "We report a 38-day-old girl with a congenital skin tag in the perianal region." }, { "field": "intervention", "quote": "Histopathological examination showed a hamartoma with disorganized skeletal muscle fibers." }, { "field": "primaryOutcome", "quote": "histopathological diagnosis should be made in children with perianal localization due to similar clinical manifestation of rhabdomyosarcoma." }, { "field": "result", "quote": "Since it does not carry the risk of recurrence and malignant transformation, it is not very important to distinguish it from these lesions." }, { "field": "result", "quote": "histopathological diagnosis should be made in children with perianal localization due to similar clinical manifestation of rhabdomyosarcoma." } ] }, { "id": "pmid:27034567", "pmid": "27034567", "doi": "10.1080/08998280.2016.11929414", "nctId": null, "pmcid": "PMC4790569", "title": "Colorectal cancer implant in an external hemorrhoidal skin tag", "firstAuthor": "Liasis", "multipleAuthors": true, "journal": "Proc (Bayl Univ Med Cent)", "year": 2016, "design": "case-series", "n": 1, "nField": "reported", "population": "a 61-year-old man with colorectal cancer", "intervention": "external hemorrhoidal skin tag examination/biopsy", "comparator": "none", "primaryOutcome": "whether the skin tag contained cancer spread", "result": "the skin tag contained a metastasis from his rectal cancer, changing his surgery", "resultDirection": "harm", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot show how common or rare this is.", "directness": "direct", "limitations": "only one patient described, no comparison group, so the frequency or risk to others with skin tags cannot be judged.", "followUp": "", "plainFinding": "Rare cancer spread into skin tag.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/27034567/", "sourceText": "External hemorrhoidal skin tags are generally benign. Colorectal cancer metastases to the squamous epithelium of perianal skin tags without other evidence of disseminated disease is a very rare finding. We present the case of a 61-year-old man with metastasis to an external hemorrhoidal skin tag from a midrectal primary adenocarcinoma. This case report highlights the importance of close examination of the anus during surgical planning for colorectal cancers. Abnormal findings of the perianal skin suggesting an implant or metastatic disease warrant biopsy, as distal spread and seeding can occur. In our patient, this finding appropriately changed surgical management.", "provenance": [ { "field": "n", "quote": "a 61-year-old man with metastasis to an external hemorrhoidal skin tag" }, { "field": "population", "quote": "a 61-year-old man with metastasis to an external hemorrhoidal skin tag from a midrectal primary adenocarcinoma" }, { "field": "intervention", "quote": "close examination of the anus during surgical planning for colorectal cancers" }, { "field": "comparator", "quote": "Abnormal findings of the perianal skin suggesting an implant or metastatic disease warrant biopsy" }, { "field": "primaryOutcome", "quote": "Colorectal cancer metastases to the squamous epithelium of perianal skin tags without other evidence of disseminated disease is a very rare finding." }, { "field": "result", "quote": "In our patient, this finding appropriately changed surgical management." } ] }, { "id": "pmid:26908665", "pmid": "26908665", "doi": "10.1542/peds.2015-2878", "nctId": null, "pmcid": null, "title": "Fistulizing Crohn's Disease Presenting After Surgery on a Perianal Lesion", "firstAuthor": "Singer", "multipleAuthors": true, "journal": "Pediatrics", "year": 2016, "design": "case-series", "n": 8, "nField": "reported", "population": "children with perianal skin lesions who later were diagnosed with Crohn's disease", "intervention": "surgery on perianal skin lesions (like skin tags)", "comparator": "no surgery / medical evaluation first", "primaryOutcome": "development of fistula and diagnosis of Crohn's disease after surgery", "result": "surgery on lesions that looked benign later revealed fistulas and led to Crohn's disease diagnosis", "resultDirection": "harm", "quality": "very-low", "qualityWhy": "this is a tiny case series of only 8 children with no comparison group, so it can't prove surgery caused harm, only that it happened in these cases", "directness": "indirect", "limitations": "small case series, no control group, selected because surgery was performed, cannot show how often skin tags alone are dangerous", "followUp": "", "plainFinding": "Surgery on tags risked missing Crohn's.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/26908665/", "sourceText": "Perianal skin lesions, such as skin tags, can be an early presenting sign of Crohn's disease. Surgical intervention on these lesions may increase the risk of fistula development and lead to worse outcomes. This case series examined 8 patients who underwent surgical intervention on what appeared to be benign perianal skin lesions, only to reveal fistulas leading to the diagnosis of Crohn's disease. This patient population comprised 20% of all pediatric patients with Crohn's disease who had perianal fistula present at diagnosis. The initial type of perianal lesion varied from case to case and included skin tags, hemorrhoids, and perianal abscesses. All of the patients had other presenting features that, in retrospect, may have been attributed to Crohn's disease. None presented solely with a perianal lesion. Four patients had weight loss or growth failure. Most of the remainder had abnormal laboratory test results. These findings should raise the awareness of primary care providers that perianal lesions can be the first presenting sign of possible Crohn's disease in otherwise healthy appearing children. Such children should undergo a thorough evaluation for Crohn's disease before surgical intervention on perianal lesions because surgical procedures may be associated with worse outcomes.", "provenance": [ { "field": "n", "quote": "This case series examined 8 patients who underwent surgical intervention" }, { "field": "population", "quote": "Perianal skin lesions, such as skin tags, can be an early presenting sign of Crohn's disease." }, { "field": "intervention", "quote": "surgical intervention on what appeared to be benign perianal skin lesions" }, { "field": "comparator", "quote": "Such children should undergo a thorough evaluation for Crohn's disease before surgical intervention on perianal lesions" }, { "field": "primaryOutcome", "quote": "only to reveal fistulas leading to the diagnosis of Crohn's disease" }, { "field": "result", "quote": "Surgical intervention on these lesions may increase the risk of fistula development and lead to worse outcomes." } ] }, { "id": "pmid:26446683", "pmid": "26446683", "doi": null, "nctId": null, "pmcid": null, "title": "Hemorrhoids and anal fissures in inflammatory bowel disease", "firstAuthor": "D'Ugo", "multipleAuthors": true, "journal": "Minerva Gastroenterol Dietol", "year": 2015, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with inflammatory bowel disease (Crohn's disease and ulcerative colitis)", "intervention": "medical therapy, with selective surgery for hemorrhoids and anal fissures", "comparator": "non-IBD population / conservative versus surgical management", "primaryOutcome": "incidence, symptoms and treatment outcomes of hemorrhoids and anal fissures in IBD", "result": "Review concludes spontaneous healing is possible, medical therapy should be tried first, and surgery should be used selectively because of higher complication risk in IBD patients", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a narrative review based on 'small series' and does not directly study whether skin tags themselves are dangerous.", "directness": "indirect", "limitations": "Abstract states literature is 'scant and based on small series'; skin tags are only mentioned once as an example of a benign condition and are not the focus of the review.", "followUp": "", "plainFinding": "Does not address skin tag danger directly.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/26446683/", "sourceText": "Perianal disease is a common complication of inflammatory bowel disease (IBD). It includes different conditions from more severe and potentially disabling ones, such as abscesses and fistulas, to more benign conditions such as hemorrhoids, skin tags and fissures. Most literature has been focused on anal sepsis and fistulae, as they carry the majority of disease burden and often alter the natural course of the disease. Hemorrhoids and anal fissures in patients with IBD have been overlooked, although they can represent a challenging problem. The management of hemorrhoids and fissures in IBD patients may be difficult and may significantly differ compared to the non-affected population. Historically surgery was firmly obstructed, and hemorrhoidectomy or sphincterotomy in patients with associated diagnosis of IBD was considered harmful, although literature data is scant and based on small series. Various authors reported an incidence of postoperative complications higher in IBD than in the general populations, with potential severe events. Considering that a spontaneous healing is possible, the first line management should be a medical therapy. In patients non-responding to conservative measures it is possible a judicious choice of surgical options on a highly selective basis; this can lead to acceptable results, but the risk of possible complications needs to be considered. In this review it is analyzed the current literature on the incidence, symptoms and treatment options of hemorrhoids and anal fissures in patients with Crohn's disease and ulcerative colitis.", "provenance": [ { "field": "population", "quote": "patients with Crohn's disease and ulcerative colitis" }, { "field": "intervention", "quote": "the first line management should be a medical therapy" }, { "field": "comparator", "quote": "higher in IBD than in the general populations" }, { "field": "primaryOutcome", "quote": "the incidence, symptoms and treatment options of hemorrhoids and anal fissures in patients with Crohn's disease and ulcerative colitis" }, { "field": "result", "quote": "Considering that a spontaneous healing is possible, the first line management should be a medical therapy." }, { "field": "result", "quote": "it is possible a judicious choice of surgical options on a highly selective basis; this can lead to acceptable results, but the risk of possible complications needs to be considered" }, { "field": "limitations", "quote": "literature data is scant and based on small series" }, { "field": "population", "quote": "hemorrhoids, skin tags and fissures" } ] }, { "id": "pmid:25746229", "pmid": "25746229", "doi": "10.1080/00325481.2015.1023160", "nctId": null, "pmcid": null, "title": "Perianal Crohn's disease: a review", "firstAuthor": "Juncadella", "multipleAuthors": true, "journal": "Postgrad Med", "year": 2015, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with perianal Crohn's disease", "intervention": "medical and surgical treatments for perianal complications of Crohn's disease, including skin tags", "comparator": "different treatment approaches and timing (e.g., surgery vs medical therapy first)", "primaryOutcome": "treatment approach and outcomes for perianal Crohn's complications", "result": "states that surgery should not be the first approach for skin tags, hemorrhoids or fissures when there is active proctitis, but does not state whether skin tags themselves are dangerous", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a general review article about Crohn's disease treatment, not a study measuring whether skin tags are dangerous, so it gives no real evidence on that question.", "directness": "indirect", "limitations": "The abstract is a narrative review of perianal Crohn's disease treatments overall; it does not focus on or specifically study the safety or danger of skin tags.", "followUp": "", "plainFinding": "No info on danger of skin tags.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/25746229/", "sourceText": "Perianal involvement in Crohn's disease (CD), which encompasses fistulas, ulcers, abscesses, strictures and cancer, can lead to significant impairment in quality of life. The objective of this article is to review the major perianal complications of CD and the current medical and surgical modalities used to treat them. Antibiotics are commonly used despite a lack of controlled trials to validate their use and should be used as a bridge to maintenance therapy. The anti-metabolites azathioprine and 6-MP have shown a positive response in terms of fistula closure, although these data are mostly from trials looking at this as a secondary endpoint. Infliximab is an effective agent for induction and maintenance of treatment of fistulizing CD. Further studies to evaluate the use of subcutaneous anti-tumor necrosis factors are needed to convincingly prove their efficacy for perianal fistulizing disease. In CD, clinicians should avoid surgery as a first-line approach for skin tags, hemorrhoids or fissures in the setting of proctitis. Surgery, particularly lateral internal sphincterotomy, in combination with medical therapy is associated with higher fissure healing rates in the absence of proctitis. Fistulotomy is curative for most simple low perianal fistulae, but complex fistulas often require sphincter-sparing surgical procedures. Less invasive approaches such as a chemical sphincterotomy should be used first, with therapy escalated only if this fails.", "provenance": [ { "field": "population", "quote": "Perianal involvement in Crohn's disease (CD), which encompasses fistulas, ulcers, abscesses, strictures and cancer, can lead to significant impairment in quality of life." }, { "field": "intervention", "quote": "The objective of this article is to review the major perianal complications of CD and the current medical and surgical modalities used to treat them." }, { "field": "result", "quote": "In CD, clinicians should avoid surgery as a first-line approach for skin tags, hemorrhoids or fissures in the setting of proctitis." }, { "field": "comparator", "quote": "Surgery, particularly lateral internal sphincterotomy, in combination with medical therapy is associated with higher fissure healing rates in the absence of proctitis." }, { "field": "primaryOutcome", "quote": "The objective of this article is to review the major perianal complications of CD and the current medical and surgical modalities used to treat them." } ] }, { "id": "pmid:24559558", "pmid": "24559558", "doi": "10.1016/j.clindermatol.2013.08.007", "nctId": null, "pmcid": null, "title": "HPV-associated diseases", "firstAuthor": "Ljubojevic", "multipleAuthors": true, "journal": "Clin Dermatol", "year": 2014, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with HPV-related skin and mucosal conditions", "intervention": "not applicable - review of HPV-associated diseases", "comparator": "", "primaryOutcome": "types of diseases and lesions associated with HPV", "result": "HPV has been detected in skin tags along with other benign and malignant conditions, but HPV can also be found on healthy skin", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is a general narrative review that only mentions skin tags briefly without specific data on risk or danger", "directness": "indirect", "limitations": "abstract does not focus specifically on anal skin tags or their danger, and does not report how often HPV is found in skin tags versus healthy skin", "followUp": "", "plainFinding": "HPV found in skin tags, meaning unclear", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/24559558/", "sourceText": "Nearly 200 distinct human papilloma viruses (HPVs) have now been recognized, and each is associated with a specific set of clinical lesions. They are associated with a spectrum of diseases, from benign verrucae vulgares and condylomata acuminata to the malignancies of the cervix, vulva, anus, and penis. Disease associated with HPV can be divided into skin and mucosal lesion of the genital and extragenital regions. The relationship between HPV and nonmelanoma skin cancer (NMSC) is important clinically, because NMSC is the most common form of malignancy among fair-skinned populations. HPVs have also been detected in skin tags, lichen sclerosus, seborrheic keratoses, actinic keratoses, epidermal cysts, psoriatic plaques, and plucked hairs, but cutaneous HPV can be found on healthy skin.", "provenance": [ { "field": "population", "quote": "Disease associated with HPV can be divided into skin and mucosal lesion of the genital and extragenital regions." }, { "field": "intervention", "quote": "HPVs have also been detected in skin tags, lichen sclerosus, seborrheic keratoses, actinic keratoses, epidermal cysts, psoriatic plaques, and plucked hairs, but cutaneous HPV can be found on healthy skin." }, { "field": "result", "quote": "but cutaneous HPV can be found on healthy skin" }, { "field": "primaryOutcome", "quote": "They are associated with a spectrum of diseases, from benign verrucae vulgares and condylomata acuminata to the malignancies of the cervix, vulva, anus, and penis." } ] }, { "id": "pmid:23044675", "pmid": "23044675", "doi": "10.1097/DCR.0b013e3182676931", "nctId": null, "pmcid": null, "title": "Mutation in TAGAP is protective of anal sepsis in ileocolic Crohn's disease", "firstAuthor": "Connelly", "multipleAuthors": true, "journal": "Dis Colon Rectum", "year": 2012, "design": "case-control", "n": 116, "nField": "reported", "population": "Adults with Crohn's disease affecting the ileum and colon, grouped by whether they had severe (abscess/fistula), mild (skin tags, fissures, pain) or no anal disease", "intervention": "Carrying a gene variant (SNP rs212388) linked to immune T-cell activation", "comparator": "Having the normal (wild-type) version of the gene", "primaryOutcome": "Whether patients developed severe (septic) anal complications versus milder anal disease versus none", "result": "Carrying the gene variant was linked to a much lower chance of severe anal sepsis, while normal-gene patients had the highest risk of abscesses, fistulas and needing a stoma", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This was a small, single-center retrospective genetic analysis with subgroups of only 17-64 patients, so the finding needs confirmation before it can be trusted.", "directness": "indirect", "limitations": "Retrospective registry analysis, small subgroup sizes, single genetic marker tested among many, no mention of correction for multiple comparisons or external validation", "followUp": "", "plainFinding": "Gene variant linked to milder, non-septic anal disease.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/23044675/", "sourceText": "BACKGROUND: Anal complications of Crohn's disease range from painless skin tags to debilitating fistulas that are imperfectly treated with tumor necrosis factor antagonists. The recent discovery of more than 190 single-nucleotide polymorphisms associated with Crohn's disease offers the opportunity to genetically define the severity of anal disease in Crohn's disease and possibly predict prognosis and anti-tumor necrosis factor response. OBJECTIVES: This study aimed to identify single nucleotide polymorphisms associated with anal disease generally, septic anal disease specifically and the responsivity to anti-tumor necrosis factor treatment. DESIGN: All patients with ileocolonic Crohn's disease were identified from our IBD registry. One hundred ninety-six Crohn's disease-related single-nucleotide polymorphisms were analyzed by the use of a custom microarray chip. Patients' response to anti-tumor necrosis factor treatment was then assessed. RESULTS: One hundred sixteen patients with ileocolonic Crohn's disease were identified and assigned to septic anal disease (abscesses/fistulas, n = 35), benign anal disease (skin tags/fissures/isolated pain, n = 17), and no anal disease (n = 64) cohorts. Single-nucleotide polymorphism rs212388 negatively correlated with the presence of anal disease overall and septic disease specifically. The presence of the non-wild-type allele 'G' was protective of anal sepsis with homo- and heterozygotes having a 75% chance of no anal disease (p = 0.0001). The homozygous wild-type group had the highest risk of septic disease and included 3 of 4 patients requiring diverting ileostomies. Twenty-four patients were treated with anti-tumor necrosis factors. Nine had a beneficial response (assessed at >6 months); however, no single-nucleotide polymorphism correlated with anti-tumor necrosis factor response. Rs212388 is associated with the TAGAP molecule involved in T-cell activation. CONCLUSIONS: Rs212388 most significantly correlated with the presence and severity of anal disease in ileocolonic Crohn's disease. A single copy of the risk allele was protective, whereas wild-type homozygotes had the highest risk of septic disease and stoma creation. In this select group, no single-nucleotide polymorphism was predictive of anti-tumor necrosis factor response. Mutations in TAGAP may predict a more benign form and course of anal disease in Crohn's disease.", "provenance": [ { "field": "population", "quote": "One hundred sixteen patients with ileocolonic Crohn's disease were identified and assigned to septic anal disease (abscesses/fistulas, n = 35), benign anal disease (skin tags/fissures/isolated pain, n = 17), and no anal disease (n = 64) cohorts." }, { "field": "n", "quote": "One hundred sixteen patients with ileocolonic Crohn's disease were identified" }, { "field": "intervention", "quote": "Single-nucleotide polymorphism rs212388 negatively correlated with the presence of anal disease overall and septic disease specifically." }, { "field": "comparator", "quote": "The homozygous wild-type group had the highest risk of septic disease and included 3 of 4 patients requiring diverting ileostomies." }, { "field": "primaryOutcome", "quote": "This study aimed to identify single nucleotide polymorphisms associated with anal disease generally, septic anal disease specifically and the responsivity to anti-tumor necrosis factor treatment." }, { "field": "result", "quote": "The presence of the non-wild-type allele 'G' was protective of anal sepsis with homo- and heterozygotes having a 75% chance of no anal disease (p = 0.0001)." } ] }, { "id": "pmid:22802557", "pmid": "22802557", "doi": "10.1136/bcr.01.2012.5667", "nctId": null, "pmcid": "PMC3416993", "title": "Obstructive perianal lesion in a 75-year-old man", "firstAuthor": "Maitra", "multipleAuthors": true, "journal": "BMJ Case Rep", "year": 2012, "design": "case-series", "n": 1, "nField": "reported", "population": "a 75-year-old man with a perianal mass", "intervention": "sugar and charcoal dressings for a fungating peri-anal mass (later treated with haemorrhoidectomy)", "comparator": "none", "primaryOutcome": "resolution of the perianal mass and final diagnosis", "result": "the mass looked malignant but was not; it resolved with dressings and shrank to a perianal skin tag, diagnosed as prolapsed haemorrhoids", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot show whether skin tags in general are dangerous.", "directness": "indirect", "limitations": "single case report; the large mass was actually prolapsed haemorrhoids, not a typical small skin tag, so it may not generalise to ordinary perianal skin tags.", "followUp": "1 month post-admission", "plainFinding": "Scary-looking mass was just hemorrhoids.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/22802557/", "sourceText": "A 75-year-old man presented with a fungating peri-anal mass which appeared malignant at presentation and required a defunctioning colostomy due to abdominal distension. Multiple biopsies were negative for malignancy and CT/MRI scans showed no malignant mass. A provisional diagnosis of prolapsed haemorrhoids was made and the mass was treated with sugar and charcoal dressings. There was a dramatic resolution of the mass with this treatment and the patient was discharged 1 month post-admission. The patient then underwent an elective haemorrhoidectomy by which time the mass had decreased to a perianal skin tag. The only clues in this case were the acute presentation of the mass, the fact that the mass had appeared post-defecation and that the patient had been diagnosed with haemorrhoids 2 years previously on colonoscopy. This case highlights the importance of evaluating all investigations and considering all differential diagnoses before embarking on definitive management.", "provenance": [ { "field": "population", "quote": "A 75-year-old man presented with a fungating peri-anal mass which appeared malignant at presentation" }, { "field": "intervention", "quote": "the mass was treated with sugar and charcoal dressings" }, { "field": "comparator", "quote": "The patient then underwent an elective haemorrhoidectomy by which time the mass had decreased to a perianal skin tag." }, { "field": "primaryOutcome", "quote": "There was a dramatic resolution of the mass with this treatment" }, { "field": "result", "quote": "the mass had decreased to a perianal skin tag" }, { "field": "n", "quote": "A 75-year-old man presented" } ] }, { "id": "pmid:22639782", "pmid": "22639782", "doi": null, "nctId": null, "pmcid": null, "title": "[HPV-associated verrucous carcinoma of the perianal region--complete remission after surgical excision and postoperative monochemotherapy with methotrexat]", "firstAuthor": "Ananiev", "multipleAuthors": true, "journal": "Akush Ginekol (Sofiia)", "year": 2012, "design": "case-series", "n": 1, "nField": "reported", "population": "48-year-old woman with a lesion in the anal skin area initially thought to be a skin tag", "intervention": "Surgical removal of the lesion followed by methotrexate chemotherapy", "comparator": "No comparator, single case followed over time", "primaryOutcome": "Whether the tumor came back after treatment", "result": "No signs of tumor recurrence six months after surgery and chemotherapy", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single patient case report, so it cannot show how often skin tags are actually this kind of cancer or what happens to others.", "directness": "indirect", "limitations": "Only one patient, short monitoring period, and the lesion was a misdiagnosed cancer rather than a true skin tag, so it does not describe outcomes for ordinary skin tags.", "followUp": "Six months later", "plainFinding": "Misdiagnosed cancer, successfully treated, not a skin tag.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/22639782/", "sourceText": "Verrucous carcinoma of the perianal area continues still to be rare finding, which in histopathological aspect is a highly differentiated form of squamous cell carcinoma. Many literature data show that it is quite possible that HPV viruses play probably a key role in the etiology of verrucous carcinoma. We present a case of 48 year-old female patient with verrucous carcinoma localized in the perianal area, treated initially under the diagnosis of perianal skin tags, while surgical removal of the lesion was found rare form of HPV associated verrucous carcinoma. A preventive mono-chemotherapy with methotrexate by scheme was started for an initial period of 3 months. Six months later, the provided monitoring has not shown clinical or apparative data on tumor recurrence. The article discusses key points of the diagnostic algorithm in patients with HPV associated lesions with anogenital localization and provides valuable recommendations for correct clinical behavior in these risk groups.", "provenance": [ { "field": "n", "quote": "a case of 48 year-old female patient" }, { "field": "population", "quote": "treated initially under the diagnosis of perianal skin tags" }, { "field": "intervention", "quote": "surgical removal of the lesion" }, { "field": "intervention", "quote": "preventive mono-chemotherapy with methotrexate" }, { "field": "comparator", "quote": "We present a case of 48 year-old female patient" }, { "field": "primaryOutcome", "quote": "the provided monitoring has not shown clinical or apparative data on tumor recurrence" }, { "field": "result", "quote": "Six months later, the provided monitoring has not shown clinical or apparative data on tumor recurrence" } ] }, { "id": "pmid:20310013", "pmid": "20310013", "doi": "10.1002/ibd.21261", "nctId": null, "pmcid": null, "title": "Nonfistulizing perianal Crohn's disease: clinical features, epidemiology, and treatment", "firstAuthor": "Bouguen", "multipleAuthors": true, "journal": "Inflamm Bowel Dis", "year": 2010, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with Crohn's disease who have perianal (anal area) lesions", "intervention": "", "comparator": "", "primaryOutcome": "clinical features and course of nonfistulizing perianal lesions, including skin tags", "result": "Skin tags themselves are usually painless, but can hide other perianal problems; anal cancer is uncommon", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is a narrative review describing typical features rather than a study testing an outcome, so it can't show whether skin tags themselves are dangerous.", "directness": "indirect", "limitations": "It is a review, not a study with its own patient data or control group, and focuses on Crohn's disease patients specifically.", "followUp": "", "plainFinding": "Skin tags themselves usually harmless, but may mask other problems.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/20310013/", "sourceText": "Nonfistulizing perianal lesions, including ulcerations, strictures, and anal carcinoma, are frequently observed in Crohn's disease. Their clinical course remains poorly known. The management of these lesions is difficult because none of the treatments used is evidence-based. Ulcerations may be symptomatic in up to 85% of patients. Most ulcerations heal spontaneously but may also progress to anal stenosis or fistula/abscess. Topical treatments only improve symptoms, while complete healing can occur in patients with perianal ulcerations receiving infliximab therapy. Half of all patients with anal strictures will require permanent fecal diversion. Dilatation for symptomatic strictures should be performed on a highly selective basis in the absence of active rectal disease in order to avoid infectious complications. Anorectal strictures associated with rectal lesions should first be managed with medical therapy. Skin tags are usually painless and may hide other perianal lesions. Anal cancer is uncommon. Its treatment is similar to that recommended for anal cancer occurring in non-Crohn's disease patients. After reviewing the classification, clinical features, and epidemiology of each type of nonfistulizing perianal lesion (ulceration, stricture, skin tags, and anal cancer), we discuss the efficacy of medical treatment and surgery. This review article may help physicians in decision-making when managing potentially disabling lesions.", "provenance": [ { "field": "population", "quote": "Nonfistulizing perianal lesions, including ulcerations, strictures, and anal carcinoma, are frequently observed in Crohn's disease." }, { "field": "result", "quote": "Skin tags are usually painless and may hide other perianal lesions." }, { "field": "result", "quote": "Anal cancer is uncommon." }, { "field": "primaryOutcome", "quote": "After reviewing the classification, clinical features, and epidemiology of each type of nonfistulizing perianal lesion (ulceration, stricture, skin tags, and anal cancer), we discuss the efficacy of medical treatment and surgery." } ] }, { "id": "pmid:19997893", "pmid": "19997893", "doi": "10.1007/s00105-009-1811-4", "nctId": null, "pmcid": null, "title": "[Acute and chronic anal ulcers]", "firstAuthor": "Weyandt", "multipleAuthors": false, "journal": "Hautarzt", "year": 2010, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with anal ulcers or skin changes near the anus", "intervention": "", "comparator": "", "primaryOutcome": "correct diagnosis of the cause of anal ulceration", "result": "the abstract describes skin tags as part of the typical pattern seen with chronic anal fissures, not as a dangerous finding on their own; it stresses that unusual symptoms need further workup to rule out other diseases including cancer", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is a descriptive narrative review discussing diagnosis, not a study testing whether skin tags themselves are harmful.", "directness": "indirect", "limitations": "abstract is general clinical guidance, not a study with data on skin tags specifically, and no patient numbers or outcomes are given.", "followUp": "", "plainFinding": "Skin tags are normal with fissures, not a warning sign themselves.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/19997893/", "sourceText": "Classic types of anal ulcers are acute and chronic anal fissure. Characteristic symptoms of chronic fissures are severe pain during defecation accompanied by the triad of ulceration, hypertrophic anal papilla and external skin tag. If the symptoms deviate other causes of ulceration must be considered. Primarily, malignancies should be excluded. The special setting in the anal fold, especially with concurrent immunosuppression, could lead to nonspecific manifestations of different proctological, dermatological and infectious diseases, which can only be clarified by further diagnostic workup and histopathology. Only the correct diagnosis will lead to causal and effective therapy. Successfully treated inflammatory dermatoses and precancerous lesions require regular follow-up because a recurrent or persistent course of the disease may result in malignant transformation.", "provenance": [ { "field": "population", "quote": "Characteristic symptoms of chronic fissures are severe pain during defecation accompanied by the triad of ulceration, hypertrophic anal papilla and external skin tag." }, { "field": "primaryOutcome", "quote": "Only the correct diagnosis will lead to causal and effective therapy." }, { "field": "result", "quote": "If the symptoms deviate other causes of ulceration must be considered. Primarily, malignancies should be excluded." } ] }, { "id": "pmid:18189031", "pmid": "18189031", "doi": null, "nctId": null, "pmcid": null, "title": "Perianal skin tags in a patient with Crohn disease and a subclinical rectal stricture", "firstAuthor": "Katz", "multipleAuthors": true, "journal": "Cutis", "year": 2007, "design": "case-series", "n": 1, "nField": "reported", "population": "a 21-year-old person with Crohn disease who had perianal skin tags", "intervention": "not applicable (observation and biopsy of perianal skin tags)", "comparator": "none", "primaryOutcome": "whether skin tags signaled worsening internal Crohn disease (rectal stricture)", "result": "the skin tags were linked to Crohn inflammation and the patient was found to have a hidden rectal stricture", "resultDirection": "harm", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot show how common or dangerous skin tags are in general.", "directness": "indirect", "limitations": "only one patient was described, and the findings may not apply to people without Crohn disease.", "followUp": "", "plainFinding": "Skin tags preceded hidden bowel damage.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/18189031/", "sourceText": "A 21-year-old female-to-male transgender individual with a history of Crohn disease presented with enlarging perianal papules that initially were misdiagnosed as condyloma acuminatum. A biopsy specimen demonstrated granulomatous inflammation characteristic of Crohn disease. Although the patient's Crohn disease had been quiescent for years, a subsequent evaluation revealed the presence of a rectal stricture that was then dilated. Perianal skin tags with granulomatous inflammation are one of many perianal manifestations of Crohn disease. Increasing numbers or size of these lesions may herald worsening of more proximal Crohn disease, as in our patient. We review the epidemiology, classification, and management of perianal skin tags in patients with Crohn disease.", "provenance": [ { "field": "n", "quote": "A 21-year-old female-to-male transgender individual with a history of Crohn disease presented with enlarging perianal papules" }, { "field": "population", "quote": "A 21-year-old female-to-male transgender individual with a history of Crohn disease presented with enlarging perianal papules" }, { "field": "intervention", "quote": "A biopsy specimen demonstrated granulomatous inflammation characteristic of Crohn disease." }, { "field": "comparator", "quote": "Perianal skin tags with granulomatous inflammation are one of many perianal manifestations of Crohn disease." }, { "field": "primaryOutcome", "quote": "Increasing numbers or size of these lesions may herald worsening of more proximal Crohn disease, as in our patient." }, { "field": "result", "quote": "a subsequent evaluation revealed the presence of a rectal stricture that was then dilated" } ] }, { "id": "pmid:15790202", "pmid": "15790202", "doi": null, "nctId": null, "pmcid": null, "title": "Long-term results after excision haemorrhoidectomy versus stapled haemorrhoidopexy for prolapsing haemorrhoids; a Belgian prospective randomized trial", "firstAuthor": "Van de Stadt", "multipleAuthors": true, "journal": "Acta Chir Belg", "year": 2005, "design": "rct", "n": 40, "nField": "reported", "population": "adults with grade II or III prolapsing hemorrhoids needing surgery", "intervention": "stapled hemorrhoidopexy (PPH)", "comparator": "Milligan-Morgan hemorrhoidectomy (MM), traditional excision surgery", "primaryOutcome": "postoperative pain, healing time, and long-term recurrence of hemorrhoid symptoms", "result": "PPH caused less pain unless skin tags were also removed, but led to more recurrent swelling/prolapse requiring repeat surgery compared to MM", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "it was a randomized trial but small, with only 20 patients per group, limiting how much weight its findings carry.", "directness": "indirect", "limitations": "small sample size of only 40 patients, single-center study", "followUp": "46 months", "plainFinding": "Stapling surgery had more recurrence needing redo.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/15790202/", "sourceText": "PURPOSE: To compare the postoperative evolution and the long-term efficacy after stapled haemorrhoidopexy (PPH) and Milligan-Morgan haemorrhoidectomy (MM). METHODS: In a prospective randomized study, 40 patients requiring surgical treatment for prolapsing haemorrhoids grade II or III were assigned to either MM or PPH (20 each). Postoperative pain, wound healing were evaluated, as well as anal pressures and sphincter anatomy. Mean follow-up is 46 months. RESULTS: Postoperative pain at rest and during defecation was less important after PPH if no resection of external piles or skin tags was associated (P < 0.0001). Healing time was shorter after PPH (P < 0.0001). Endoanal ultrasound remained unchanged postoperatively. Resting and squeeze pressures decreased after MM, but not after PPH (P < 0.01). After a mean follow-up of 46 months (12-56), persistent or recurrent symptoms, mostly mild and temporary, were observed after both MM and PPH, in 7 and 11 patients respectively (NS). After PPH, five patients (25%) complained of recurrent external swelling and/or prolapse (P = 0.047 vs. MM) requiring redo surgery in four of them, after 10, 13, 14 and 21 months. No redo-surgery was required after MM. Long term patient satisfaction after PPH was not better than after MM. CONCLUSIONS: Postoperative pain is less important after PPH. This advantage disappears if any resection is associated with the stapling. At medium to long-term follow-up, PPH seems to carry a higher risk of symptomatic external haemorrhoidal disease, needing further surgery.", "provenance": [ { "field": "population", "quote": "40 patients requiring surgical treatment for prolapsing haemorrhoids grade II or III" }, { "field": "intervention", "quote": "stapled haemorrhoidopexy (PPH)" }, { "field": "comparator", "quote": "Milligan-Morgan haemorrhoidectomy (MM)" }, { "field": "primaryOutcome", "quote": "Postoperative pain, wound healing were evaluated, as well as anal pressures and sphincter anatomy" }, { "field": "result", "quote": "Postoperative pain at rest and during defecation was less important after PPH if no resection of external piles or skin tags was associated (P < 0.0001)." }, { "field": "result", "quote": "After PPH, five patients (25%) complained of recurrent external swelling and/or prolapse (P = 0.047 vs. MM) requiring redo surgery in four of them" }, { "field": "n", "quote": "40 patients requiring surgical treatment for prolapsing haemorrhoids grade II or III were assigned to either MM or PPH (20 each)." } ] }, { "id": "pmid:15227686", "pmid": "15227686", "doi": "10.1002/bjs.4613", "nctId": null, "pmcid": null, "title": "Perianal Crohn's disease", "firstAuthor": "Singh", "multipleAuthors": true, "journal": "Br J Surg", "year": 2004, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with perianal Crohn's disease", "intervention": "", "comparator": "", "primaryOutcome": "types of perianal Crohn's disease manifestations and treatment outcomes", "result": "skin tags are listed as one of several manifestations of perianal Crohn's disease, alongside ulcers, fissures, abscesses, fistulas and stenoses", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a narrative review describing treatment options generally, not a study testing whether skin tags themselves are dangerous.", "directness": "indirect", "limitations": "abstract does not specifically address whether isolated skin tags (outside Crohn's disease) carry risk; it only notes skin tags as one feature of Crohn's-related perianal disease.", "followUp": "", "plainFinding": "Skin tags can signal Crohn's disease.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/15227686/", "sourceText": "BACKGROUND: The management of perianal Crohn's disease is difficult. A wide variety of treatment options exist although few are evidence based. METHODS: A search was conducted using the National Library of Medicine for articles on perianal Crohn's disease and its incidence, classification, assessment and management. RESULTS AND CONCLUSION: Perianal Crohn's disease can manifest as skin tags, ulcers, fissures, abscesses, fistulas or stenoses. Improved radiological imaging with endoanal anal ultrasonography and magnetic resonance imaging has improved its assessment and may be used to predict outcome after surgery. Many treatment options exist. During acute complications they are generally aimed at resolving the immediate problem and limiting damage to anal and perianal tissues; this may be a 'bridge' to definitive treatment. The likelihood of success of definitive treatment must be weighed against the risk of complications, especially faecal incontinence.", "provenance": [ { "field": "population", "quote": "perianal Crohn's disease" }, { "field": "result", "quote": "Perianal Crohn's disease can manifest as skin tags, ulcers, fissures, abscesses, fistulas or stenoses." }, { "field": "primaryOutcome", "quote": "its incidence, classification, assessment and management" } ] }, { "id": "pmid:9194457", "pmid": "9194457", "doi": "10.1007/BF02140892", "nctId": null, "pmcid": null, "title": "Outcome of the pelvic pouch procedure in patients with prior perianal disease", "firstAuthor": "Richard", "multipleAuthors": true, "journal": "Dis Colon Rectum", "year": 1997, "design": "retrospective", "n": 753, "nField": "reported", "population": "patients with ulcerative colitis or indeterminate colitis who had pelvic pouch surgery, some with prior perianal disease including skin tags", "intervention": "having prior perianal disease (including fissures, abscesses, fistulas, hemorrhoids/skin tags) before pelvic pouch surgery", "comparator": "patients with no prior perianal disease before pelvic pouch surgery", "primaryOutcome": "rates of anastomotic leak, perianal complications, and overall pouch failure after surgery", "result": "Patients with prior perianal disease had higher leak and complication rates, but overall pouch failure was not significantly different, and outcomes did not differ by type of perianal lesion (including skin tags)", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This is a retrospective surgical outcomes study with a small subgroup (25 patients) having skin tags lumped together with other perianal conditions, so it can't show whether skin tags specifically are risky.", "directness": "indirect", "limitations": "Skin tags were combined with hemorrhoids and analyzed only as part of a broader perianal disease group alongside fissures, abscesses, and fistulas, not studied alone; this is about surgical pouch outcomes in IBD patients, not general risk of anal skin tags.", "followUp": "", "plainFinding": "Lesion type didn't predict worse outcomes.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/9194457/", "sourceText": "PURPOSE: There is concern that patients with presumed ulcerative colitis and significant perianal disease may in fact have Crohn's disease. Moreover, prior perianal disease may be an independent factor for poor outcome of the pelvic pouch. The aim of this study was to evaluate the effect of prior perianal disease on pelvic pouch outcome. METHODS: Between 1982 and 1994, 52 of 753 patients (6.9 percent) who had a pelvic pouch procedure were prospectively identified as having perianal disease. Outcome of the pelvic pouch of these 52 patients (Group I) were compared with the outcome of 701 pelvic pouch patients with no prior perianal disease (Group II). The perianal diseases identified in Group I were fissure-in-ano (17), perianal abscesses (13), fistula-in-ano (7), rectovaginal fistula (3), and significant hemorrhoids/skin tags (25). Eleven patients (21 percent) had more than one type of perianal disease. Twenty-seven patients (52 percent) required a total of 33 perianal operations for the different anal pathologies. RESULTS: Both groups were comparable for the following characteristics: age at time of pelvic pouch procedure, pathology (ulcerative colitis or indeterminate colitis), design of pouch, and type of ileoanal anastomosis (handsewn or stapled). An ileoanal anastomosis leak developed in 21 percent of patients (n = 11) in Group I vs. 11.4 percent (n = 80) in Group II (P < 0.05). Perianal postoperative complications occurred in 11.5 percent of patients (n = 6) in Group I vs. 1.7 percent (n = 12) in Group II (P < 0.05). Total pouch failure rate was not significantly different between the two groups (11.5 vs. 7.6 percent; P > 0.05). Crohn's disease was subsequently diagnosed in 1.9 vs. 2.7 percent (P > 0.05). Subgroup analysis of Group I patients showed no significant difference in outcome according to type of perianal lesion or a history of perianal surgery. CONCLUSION: Prior perianal disease significantly increases the risk of developing an ileoanal anastomotic leak and postoperative perianal complications. However, a pelvic pouch procedure may be an acceptable surgical alternative for selected ulcerative colitis patients with prior perianal disease because the overall pouch failure rate is not significantly increased.", "provenance": [ { "field": "n", "quote": "52 of 753 patients (6.9 percent) who had a pelvic pouch procedure were prospectively identified as having perianal disease" }, { "field": "population", "quote": "patients with presumed ulcerative colitis and significant perianal disease" }, { "field": "intervention", "quote": "significant hemorrhoids/skin tags (25)" }, { "field": "comparator", "quote": "compared with the outcome of 701 pelvic pouch patients with no prior perianal disease (Group II)" }, { "field": "primaryOutcome", "quote": "The aim of this study was to evaluate the effect of prior perianal disease on pelvic pouch outcome." }, { "field": "result", "quote": "Subgroup analysis of Group I patients showed no significant difference in outcome according to type of perianal lesion or a history of perianal surgery." }, { "field": "result", "quote": "Total pouch failure rate was not significantly different between the two groups (11.5 vs. 7.6 percent; P > 0.05)." } ] }, { "id": "pmid:6479689", "pmid": "6479689", "doi": "10.1136/gut.25.10.1124", "nctId": null, "pmcid": "PMC1432553", "title": "Malignant transformation of anal skin tags in Crohn's disease", "firstAuthor": "Somerville", "multipleAuthors": true, "journal": "Gut", "year": 1984, "design": "case-series", "n": 1, "nField": "reported", "population": "young man with Crohn's disease affecting the ileum and perianal area", "intervention": "anal skin tags related to Crohn's disease", "comparator": "", "primaryOutcome": "whether anal skin tags became cancerous", "result": "the anal skin tags turned into cancer", "resultDirection": "harm", "quality": "very-low", "qualityWhy": "this is a single patient case report, which cannot show how often this happens or why", "directness": "indirect", "limitations": "only one patient described; no comparison group; cannot show typical risk for people with ordinary skin tags", "followUp": "", "plainFinding": "Rare case of skin tag turning cancerous.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/6479689/", "sourceText": "The anal skin tags of a young man with ileal and perianal Crohn's disease underwent malignant transformation. This was not associated with immunosuppressive drug therapy and has not been previously described.", "provenance": [ { "field": "population", "quote": "The anal skin tags of a young man with ileal and perianal Crohn's disease" }, { "field": "intervention", "quote": "The anal skin tags of a young man with ileal and perianal Crohn's disease underwent malignant transformation." }, { "field": "primaryOutcome", "quote": "underwent malignant transformation" }, { "field": "result", "quote": "underwent malignant transformation" }, { "field": "n", "quote": "a young man" } ] } ], "faqs": [ { "q": "Is an anus skin tag dangerous?", "a": "Usually not — most anal skin tags are leftover skin from an old hemorrhoid or healed fissure. But the direct evidence is only two small case reports, and one of them did find a cancer hidden inside a tag, so a new or changing tag is worth having a doctor look at." }, { "q": "Are skin tags around the anus dangerous?", "a": "The studies on this are too few and too mixed to say for certain either way. One case found a cancer deposit inside a tag; another found a tag that looked scary but was harmless. Neither result tells you what's typical." }, { "q": "Are anal tags dangerous?", "a": "In the cases that have been reported, most anal tags turned out to be harmless, but a few individual case reports describe tags linked to cancer or to hidden Crohn's complications. There isn't a large study that tells you the overall odds." }, { "q": "Are anal warts dangerous?", "a": "Warts and skin tags are different things — warts are caused by HPV, a virus, while tags are usually leftover skin. One review found HPV can sometimes be detected in skin tags too, but it didn't measure how often or what that means, so this page's evidence doesn't directly answer the wart question." }, { "q": "Is anal dangerous?", "a": "If you're asking about a bump or skin tag near the anus, the honest answer is that the evidence is too thin to say it's dangerous or safe in general — it's usually harmless, but a doctor should check anything new, growing, bleeding, or painful." } ], "searchedAs": [ "anus skin tag is dangerous", "are skin tags around anus dangerous", "are anal tags dangerous", "are anal warts dangerous", "is anal dangerous" ], "patientTakeaway": "A skin tag at the anus is usually nothing more than leftover skin from an old hemorrhoid or healed fissure, and nothing here shows that tags commonly turn cancerous. But because a handful of case reports found a tag hiding something serious — a cancer deposit or a Crohn's complication — get any tag checked by a doctor if it's new, growing, bleeding, painful, or looks different from the others, rather than trying to judge it yourself.", "methodology": { "databases": [ "PubMed", "ClinicalTrials.gov", "Crossref" ], "searchStrings": { "pubmed": "(\"Skin Tags\"[tiab] OR \"acrochordon\"[tiab] OR \"skin tag\"[tiab] OR \"Skin Tags\"[tiab]) AND (\"Anus Diseases\"[Mesh] OR \"Anal Canal\"[Mesh] OR anal[tiab] OR perianal[tiab] OR anus[tiab]) AND (malignant[tiab] OR malignancy[tiab] OR cancer[tiab] OR neoplasm[tiab] OR risk[tiab] OR biopsy[tiab] OR dangerous[tiab])" }, "pubmedQueryTranslation": "(\"Skin Tags\"[Title/Abstract] OR \"acrochordon\"[Title/Abstract] OR \"skin tag\"[Title/Abstract] OR \"Skin Tags\"[Title/Abstract]) AND (\"Anus Diseases\"[MeSH Terms] OR \"Anal Canal\"[MeSH Terms] OR \"anal\"[Title/Abstract] OR \"perianal\"[Title/Abstract] OR \"anus\"[Title/Abstract]) AND (\"malignant\"[Title/Abstract] OR \"malignancy\"[Title/Abstract] OR \"cancer\"[Title/Abstract] OR \"neoplasm\"[Title/Abstract] OR \"risk\"[Title/Abstract] OR \"biopsy\"[Title/Abstract] OR \"dangerous\"[Title/Abstract])", "searchedOn": "2026-10-13", "inclusion": [ "Human, animal or laboratory studies reporting an outcome relevant to the question" ], "exclusion": [ "Records about a different condition or intervention", "Records reporting no outcome", "Retracted publications, which are listed but excluded from every count" ], "extractionLevel": "abstract", "gradingNote": "Evidence strength is adapted from the GRADE framework. It is not a GRADE assessment and was not produced by a GRADE panel.", "limits": [ "Fields were read from abstracts, not full text, so detail reported only in a paper's methods section is not captured." ] }, "seo": { "title": "Is an anal skin tag dangerous?", "description": "Only 2 small case reports directly tested whether anal skin tags are dangerous, and they point in different directions. See what the evidence shows." }, "lastChecked": "2026-10-13", "lastChanged": "2026-10-13", "nextCheckDue": "2026-11-13", "history": [], "pipeline": { "screenModel": "claude-haiku-4-5", "extractModel": "claude-sonnet-5", "composeModel": "claude-sonnet-5", "promptVersion": "ev-1", "ranOn": "2026-10-13" }, "status": "published" }