brand logo

Am Fam Physician. 2023;108(1):89-90

Author disclosure: No relevant financial relationships.

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

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


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

  • A. Dermatofibroma.

  • B. Dermatosis papulosa nigra.

  • C. Fibroepithelial polyp.

  • D. Seborrheic keratosis.


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

The prevalence increases with age; 50% to 60% of fibroepithelial polyps occur in adults older than 50 years. The formation of fibroepithelial polyps is not fully understood. Frequent skin rubbing and changes in epithelial sensitivity to hormones are proposed etiologies. Hormonal changes in conditions such as pregnancy, obesity, and diabetes mellitus may be associated with polyp growth.13

Smaller lesions (less than 5 mm) can be treated with cryotherapy or cauterization. Surgical excision is required for larger polyps.2

Dermatofibroma is a benign proliferation of fibroblasts appearing as a firm, raised, tan to reddish-brown papule or nodule, usually on the legs. Lesions are typically 3 to 10 mm in diameter and produce the dimple sign when laterally squeezed. The patient may report a history of local trauma (e.g., insect bite) or subcutaneous puncture (e.g., splinter).4,5

Dermatosis papulosa nigra is a benign skin condition characterized by pigmented filiform papules in the malar or temple region, neck, and upper trunk of individuals with darker skin tones. Lesions can be 1 to 5 mm in diameter, with a 1- to 3-mm elevation. Dermatosis papulosa nigra has a male to female ratio of 1: 2.6

Seborrheic keratosis is a benign skin growth of immature keratinocytes. It is the most common benign skin tumor in the older population. The yellow to brown lesions are highly pigmented, sharply demarcated, and soft to the touch. They may feel slightly greasy, velvety, or warty. They are commonly described as waxlike with a “stuck on” appearance.4

DermatofibromaFirm, raised, tan to reddish-brown papule or nodule, usually on the legs; 3 to 10 mm in diameter; produces the dimple sign when laterally squeezed.
Dermatosis papulosa nigraPigmented filiform papules, commonly seen on malar or temple region, neck, and upper trunk of individuals with darker skin tones
Fibroepithelial polypSmall, slightly demarcated, papillomatous lesion often seen in skin creases and areas exposed to friction
Seborrheic keratosisHighly pigmented, sharply demarcated, soft to the touch; waxlike with a “stuck on” appearance
Already a member/subscriber?  Log In


From $145
  • Immediate, unlimited access to all AFP content
  • More than 130 CME credits/year
  • AAFP app access
  • Print delivery available

Issue Access

  • Immediate, unlimited access to this issue's content
  • CME credits
  • AAFP app access
  • Print delivery available
Purchase Access:  Learn More

The editors of AFP welcome submissions for Photo Quiz. Guidelines for preparing and submitting a Photo Quiz manuscript can be found in the Authors' Guide at To be considered for publication, submissions must meet these guidelines. Email submissions to

This series is coordinated by John E. Delzell Jr., MD, MSPH, associate medical editor.

A collection of Photo Quiz published in AFP is available at

Continue Reading

More in AFP

More in Pubmed

Copyright © 2023 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See permissions for copyright questions and/or permission requests.