Removal of skin tags: scissor excision versus non-ablative 532nm-LBO-laser in a randomized intraindividual controlled observer-blinded clinical trial

Fibroma pendulans, commonly known as skin tag, is a benign protrusion of connective tissue that often develops groupwise in areas subjected to mechanical friction. Although generally harmless, they can become cosmetically concerning or painful if infarcted. Traditional removal methods, such as electrocautery and cryotherapy, often result in hypopigmentation or scarring. Lasers became interesting for skin-tag removal, but are they really more effective than classical scissor snip exisions? This study aimed to compare the efficacy, healing outcomes, and patient acceptance of scissor snip excision versus 532 nm LBO laser therapy for the removal of skin tags. 68 patients with a total of 1,257 fibromas located on the neck or axillae were treated. Each patient received both treatments in a randomized split-neck/axillar manner. Fibromas were either excised using scissors or treated with the non-ablative 532 nm LBO laser. Outcomes were evaluated at 4 and 12 weeks post-treatment, focusing on complete healing, patient preference, pain perception, and cosmetic results. At 12 weeks, the scissor excision group exhibited a significantly higher healing rate of 85% compared to 71% in the laser group (p = 0.00001). The adjusted overall response rate was 92.64% for scissor excision and 84.19% for laser treatment. Patient preference favored scissor excision, with 63% of patients opting for this method for future treatments, while 19% preferred the laser, and 18% were indifferent. Pain scores were lower for scissor excision (mean: 2.6) compared to laser treatment (mean: 3.42). Laser therapy was 39% faster than scissor excision when accounting for wound dressing, although it had higher rates of redness, hyper- and hypopigmentation. The bloodless nature of the laser and the absence of dressings were perceived as advantages, but the persistence of necrotic fibromas for up to three weeks was a notable drawback. Despite the perceived advantages of a bloodless and dressing-free procedure with the 532 nm LBO laser, scissor snip excision demonstrated superior healing outcomes, lower pain scores, and higher patient satisfaction. These findings suggest that scissor snip excision remains the gold standard for treating pedunculated fibromas, though further studies exploring the effect of the 532 nm laser on small disseminated fibromas and other laser modalities are warranted.