Lipomas

Lipomas are commonly found on routine skin examinations and ... Read more...

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Topics

• What causes Lipomas?

• Can lipomas be treated (shrunk or eliminated) without surgery?

• If surgically removed, what’s the likelihood of a lipoma recurring?

• Aside from being unsightly, are lipomas a health danger?

• Which syndromes are associated with lipomas?

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What causes Lipomas?

Lipomas are benign tumors made up of adipose or fatty tissue. They are very common. In fact, lipomas are considered the most common soft tissue tumors of the body. It is unclear what the true cause for lipomas to develop is, however, genetics is thought to play a potential role. Occasionally, people will note a family history of lipomas. There are even genetic syndromes that include lipomas such as hereditary multiple lipomatosis, Madelung's disease, Dercum’s disease, and Gardner’s syndrome.

In practice, I often find that the lipomas patients present with concerns for removal are noted in high friction or trauma areas such as the ventral forearm where the arm leans against a desk or a counter, the mid-lateral back where the back rests against a chair, or after a bump or hit on the thigh after healing. It is difficult to say with certainty if trauma to the body actually causes lipomas to develop. This has been a source of controversy as studies have not been able to confirm a cause and effect.

Can lipomas be treated (shrunk or eliminated) without surgery?

Treatment options for lipomas depend on size and location. Remember that although we often think about lipomas associated with the skin, lipomas can actually occur anywhere in the body where adipose tissue is found.

Small superficial lipomas can potentially be minimized or shrunk nonsurgically by steroid injections to cause atrophy of the fatty tissue. Some patients with numerous and/or multiple small lipomas may consider this option for some limited cosmetic improvement. The challenge with this approach, in my experience, is that it potentially only benefits small lipomas (less than 1 cm in size). This procedure also tends to have a high recurrence or return rate simply because it is only shrinking the size but not eliminating the lipoma altogether.

Liposuction has also been used to treat lipomas. This would still be considered surgical, albeit, with a potentially reduced risk of scarring.

Surgical excision remains the mainstay of treatment options for many lipomas.

If surgically removed, what is the likelihood of a lipoma recurring?

The likelihood of a lipoma recurrence after surgical excision truly depends on several factors:

• Type of lipoma: encapsulated or diffuse

• The presence of a deeper component that may have involved the fascia or muscle is referred to as a deep-seated lipoma.

The recurrence rate is around 5% post-surgical, however, this rate may go up based on these factors.

Aside from being unsightly, are lipomas a health danger?

Most lipomas are considered benign without impacting our general health. However, based on location, symptoms, and increases in size, they do have potential risks.

• If a lipoma develops along the neck, depending on location, it can potentially pose a risk to breathing or swallowing.

• Painful lipomas can affect our day-to-day activities, posture, or exercise.

• Although very rare, liposarcoma, a malignant lipoma, can occur. For lipomas increasing in size, it is important to have them evaluated by your Dermatologist to rule out this possibility.

Occasionally patients may perceive a lipoma to be increasing in size when in fact they are likely stable with an increase in muscle mass behind the lipoma making them appear more prominent. I routinely ask patients that note a possibly expanding lipoma about new exercise routines to determine the possibility that this may be playing a role in the perceived change in size.

Which syndromes are associated with lipomas?

Madelung’s Disease	Lipomas that develop around the neck and shoulders, potentially impairing breathing. This condition is most often noted in adult males with excessive drinking.
Dercum’s Disease	A condition characterized by multiple painful lipomas that can occur on the trunk and extremities. Given the painful nature and location of these tumors, daily activities can be affected.
Gardner’s Syndrome	A genetic condition with multiple lipomas, polyps (noncancerous and potentially cancerous) in the colon, and extra teeth, in addition to cysts and bony tumors, called osteomas. Patients that present with a combination of multiple lipomas, cysts, and/or bony tumors should be considered for colonoscopy if they have not yet reached the age of a screening colonoscopy given this risk.
Hereditary multiple lipomatosis	This genetic condition is characterized simply by multiple lipomas that do not necessarily pose a health risk.