History and exam
Key diagnostic factors
common
presence of risk factors
Key risk factors include a genetic predisposition due to familial multiple lipomatosis, Gardner's syndrome, or Bannayan-Riley-Ruvalcaba's syndrome.
cutaneous mass <5 cm diameter
soft cutaneous mass
Lipomas tend to be soft and doughy in texture, similar to the consistency of subcutaneous fat. A firm texture may indicate liposarcoma. A smooth but tense superficial lesion may represent an epidermoid cyst.
mobile cutaneous mass
Most cutaneous lipomas are mobile. If a lesion appears fixed or tethered to the underlying fascia, a liposarcoma should be ruled out using imaging and biopsy.
superficial cutaneous mass
Most cutaneous lipomas are superficial. If a lesion seems deep to the superficial fascia, imaging should be considered to rule out liposarcoma.[16]
Other diagnostic factors
uncommon
painless cutaneous mass
Most lipomas are painless but can cause some discomfort if they undergo abrasion from clothing. Angiolipomas, which tend to be multiple and occur in young adults, can sometimes be painful to touch. Chronic pain is present in Dercum's disease but not in lipomatosis.
gastrointestinal obstruction
Risk factors
strong
genetic predisposition
The hereditary condition of familial multiple lipomatosis is characterised by multiple lipoma development.[9][10] Patients with this autosomal condition tend to be male and have widespread symmetric lipomas of the extremities and trunk.[11] Lipomatosis may also be associated with Madelung's disease, Dercum's disease, and Gardner's syndrome.[21] Studies have shown a correlation between HMG 1-C gene mutation and lipoma development.[22]
weak
trauma
heavy alcohol consumption
Madelung's disease, also known as multiple symmetric lipomatosis, features benign symmetric lipomatosis of the head, neck, shoulders, and proximal upper extremities. It is more common in men and is associated with chronic alcohol consumption in genetically predisposed individuals.[13]
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