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Moles, Warts and Skin Tags Removal

Skin Tags Removal Ebook By Charles Davidson

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Secondary tumours

Metastases to the anal canal and perianal skin are rare. Most primaries are found in the rectum or colon, but occasionally also in the respiratory tract, breast and pancreas {157, 182, 379, 888, 1767, 489}. There are few reports of metastatic squa-mous cell carcinoma {574}. Malignant lymphoma, leukaemia and myeloma may infiltrate the anal canal, and eosinophilic granuloma has also been described {489}.

Clinically, anal metastases cause similar symptoms to primary tumours at this site, including pain, bleeding and incontinence.

Neoplasia-like lesions Fibroepithelial polyp

Also called fibrous polyp or anal tag, this is one of the most frequent anal lesions. It may be found in the squamous zone or the perianal skin in up to half of all individuals {2101}. Grossly, the polyp is spherical or elongated with a greater diameter ranging from a few mm up to 4 cm. The surface is white or grey and may show superficial ulceration. Histo-logically, it consists of a fibrous stroma covered by squamous epithelium, which usually is slightly hyperplastic and may be keratinized. The stroma may be more or less dense and often contains fibroblastic cells with two or more nuclei and a considerable number of mast cells {630}. Neuronal hyperplasia is a common feature {495}.

Fibroepithelial polyps may be associated with local inflammation such as fissure or fistula {1084}.

Granulomas can be found in about one third of skin tags in cases of Crohn's disease {1905}. Others may represent the end stage of a thrombosed haemorrhoid, but remnants of haemorrhoidal vessels or signs of previous bleeding are rarely found. Most are probably of idiopathic nature as the incidence is rather similar in patients with or without anal diseases {2101}.

Inflammatory cloacogenic polyp

This polyp was first described in 1981 {1083}. It arises in the ATZ and forms a rounded or irregular mass measuring from 1 to 5 cm in diameter. Histologically, it consists of hyperplastic rectal mucosa, partly covered with ATZ type or squa-mous epithelium. The surface is typically eroded and the stroma shows oedema, vascular ectasia, inflammatory cells and granulation tissue. Vertically oriented smooth muscle fibres are found between the elongated and tortuous crypts. The inflammatory cloacogenic polyp is commonly associated with mucosal prolapse, sometimes in company with haemorrhoids {296, 1052}.

Malacoplakia

Cutaneous malacoplakia may arise in immunocompromised patients and present as perianal nodules {1102}.

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