Lipoma

Lipomas can occur in a wide variety of sites. The position, size, likely differential, and other characteristics of a lesion determine which treatments are feasible and appropriate. Since lipomas do not have malignant potential they do not necessarily have to be removed, but this course of action depends on a number of factors, the most notable being the likelihood that the lesion could be a liposarcoma.

Lipomas are removed if they become painful or bothersome to the patient.[5]Salam GA. Lipoma excision. Am Fam Physician. 2002 Mar 1;65(5):901-4. https://www.aafp.org/pubs/afp/issues/2002/0301/p901.html http://www.ncbi.nlm.nih.gov/pubmed/11898962?tool=bestpractice.com They are also often removed if they increase in size, if there is any concern that they may be a liposarcoma or for cosmetic reasons.[16]Dalal KM, Antonescu CR, Singer S. Diagnosis and management of lipomatous tumors. J Surg Oncol. 2008 Mar 15;97(4):298-313. http://www.ncbi.nlm.nih.gov/pubmed/18286473?tool=bestpractice.com Approximately 1% to 2% of surgically resected lipomas recur.

Excision is usually achieved under local anaesthesia, although general anaesthesia may be appropriate if multiple lesions need to be removed or lesions are large. Incisions should follow Langer lines or the long axis of the extremity, depending on the precise location of the lesion. Once the lipoma is removed, the skin is closed using buried, interrupted 2.0 or 3.0 vicryl sutures in the dermal layer.

The skin is then approximated using 3.0 or 4.0 nylon vertical mattress suture vicryl sutures or monocryl as a running subcuticular suture. Sutures are removed after 5 to 14 days, depending on the location of the tumour. Specimens are submitted for histological analysis.

For patients with Dercum's disease, treatment includes symptom management, including excision of the most painful lipomas. Referral to a multidisciplinary team with expertise in chronic pain management is recommended.[12]Hansson E, Svensson H, Brorson H. Review of Dercum's disease and proposal of diagnostic criteria, diagnostic methods, classification and management. Orphanet J Rare Dis. 2012 Apr 30;7:23. https://www.doi.org/10.1186/1750-1172-7-23 http://www.ncbi.nlm.nih.gov/pubmed/22546240?tool=bestpractice.com ​​

If gastrointestinal tract lipomas are sufficiently large to be causing obstructive symptoms or significant bleeding, then surgical excision is indicated.[46]Sharzehi K, Sethi A, Savides T. AGA clinical practice update on management of subepithelial lesions encountered during routine endoscopy: expert review. Clin Gastroenterol Hepatol. 2022 Nov;20(11):2435-43.e4. https://www.doi.org/10.1016/j.cgh.2022.05.054 http://www.ncbi.nlm.nih.gov/pubmed/35842117?tool=bestpractice.com This may be achieved by laparoscopic or open segmental resection depending on the exact location of the lipoma.

Treatment of lipomas that arise in unusual sites such as the parotid glands, parapharyngeal space, breast, mediastinum, pleura, airways, heart, superior vena cava, brain, and intraspinal areas are considered on a case-by-case basis.

The general principle of treatment of such cases is close observation. However, if there is a concern that the lesion could potentially be a liposarcoma, surgical excision is indicated.