Lipomas

Lipomas are mature adipose tissue arranged in a nodular formation surrounded by a capsule and commonly located in the subcutaneous tissues. Lipomas can be diagnosed by clinical examination and identification of their unique, well-circumscribed, round, mobile character with a doughy consistency. Although most do not require it, excision may be considered for large tumors, rapidly growing lipomas, and those causing pain. Lipomas can occur in isolation or with other systemic diseases, as a component of genetically inherited disorders, or in other connective tissue layers.

A steroid injection or liposuction can be used to treat select lipomas. Steroid injections can be used to treat painful lipomas less than 1 inch (2.5 cm) in size and in which pathologic examination is likely unnecessary. An injection of 1 to 3 mL of triamcinolone diluted with 1% lidocaine to a 10 mg/mL concentration can be performed into the center of the lipoma monthly to shrink the tumor to the desired size. Formal liposuction can be done with cannula or 16-gauge syringe under local anesthesia (Salam, 2002). Neither of these procedures is likely to eliminate the lipoma in its entirety, and recurrences are frequent.

Surgical excision of a lipoma removes the neoplasm from the tissue and allows for pathologic examination. Marking the boundaries of the lipoma is helpful for identification of the tumor edges before a local anesthetic field block is placed. The skin is prepared with a povidone-iodine or chlorhexidine solution. Small lipomas can be enucleated with their capsule using blunt dissection through a small incision. Larger lipomas require excision through a linear or elliptic incision. Blunt and sharp dissection can be used to free the mass from the surrounding tissues using hemo-stats or clamps for traction. Hemostasis should be confirmed and cautery or ligature placement used to ensure a dry wound base. The remaining dead space is closed with buried, interrupted, dissolvable subcutaneous sutures and the skin closed with interrupted sutures or staples depending on location and cosmetic need. A compression dressing should be used for 1 to 2 days to prevent formation of a hematoma, and sutures are removed in 5 to 10 days depending on location. Submit any specimen for pathologic examination. (See Tuggy Video: Lipoma Removal.)

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