Lipoma

A lipoma is a lump of tissue that grows just below the skin. It can be of any shape and is predominantly oval or round-shaped. A lipoma is composed of fat cells. They are included under the category of benign soft tissue tumours (i.e., they are non-cancerous).

They grow slowly and painlessly and can appear anywhere on the body. Lipomas are not attached to any underlying structures other than the skin and hence move easily on touch. Most lipomas do not cause symptoms and, hence, do not require treatment.

(Read more: What is the difference between a tumour and cancer)

The symptoms of a lipoma are:

• Soft to touch, rubbery in consistency like a soft squeeze ball
• They appear usually on the back, trunk (torso), arms, shoulder or neck. However, they can occur in other places of the body as well.
• Generally small (usually 2 to 5 cm) and slow-growing
• Usually painless, unless it is pressing on nerves or contains blood vessels
• They move easily underneath the skin when touched
• Encapsulated (they do not spread to the nearby tissues)

Lipomas are very common. About 1 in every 1000 people has a lipoma. The various factors that may lead to lipoma include:

• Age: lipomas can occur at any age but are mostly seen between ages 40 and 60 years
• Gender: lipomas are slightly more common in females as compared to males
• Family history: chance of developing a lipoma is higher for people who have a family history of lipomas
• Genetics: certain genetic disorders and conditions predispose people to develop lipomas. These include
  • Adiposis dolorosa or Dercum’s disease (a rare disorder characterized by multiple, painful lipomas)
  • Cowden syndrome
    • Gardner’s syndrome (infrequently): this is an inherited condition that causes benign and malignant tumours to form
  • Madelung’s disease: occurs mostly in men who are heavy drinkers
  • Bannayan-Riley-Ruvalcaba syndrome
• Obesity
• Alcoholism
• Liver diseases
• Diabetes

Lipomas and the associated factors responsible for their development (genetic conditions) are inherited. Since they can pass through families, it is not possible to prevent them from occurring. However, healthy lifestyle modifications aimed to control obesity may delay its occurrence. In Madelung’s disease (a condition that causes lipomas to grow), reducing alcohol consumption lowers the risk of developing lipomas.

The doctor can diagnose a lipoma with the help of a physical examination. The doctor while pressing the swelling will ask if the patient feels pain.

In some cases, a biopsy may be taken from the swelling. A biopsy is a sample of tissue which is taken from the swelling. The biopsy is sent for pathological examination. This is done to rule out any possibility of cancer (some lipomas can mimic a cancerous growth known as liposarcoma – which is often painful, grows quickly and cannot be moved around on touch). Based on the contents of the lipoma which is determined by the pathological examination, it can be further classified as:

• Conventional lipoma: it is the most common type which contains white fat cells. These fat cells store energy.
• Angiolipoma: this type contains fat and blood vessels. They are often associated with pain.
• Fibrolipoma: this type contains fat and fibrous tissue.
• Hibernoma: this type contains a different variety of fat cells known as brown fat cells. These fat cells are responsible for generating heat and helping regulate body temperature.
• Myelolipoma: this type contains fat cells and tissues that produce blood cells (similar to tissues present in the bone marrow).
• Spindle cell lipoma: in this type of lipoma the fat cells are long and spindle-shaped.
• Pleomorphic: this type of lipoma has fat cells of varying sizes and shapes.

Imaging studies such as ultrasound, CT scan or MRI may also be done. This helps differentiate the lipoma from a cyst (fluid-filled swelling) and also helps in determining the exact size of the lipoma and whether or not it contains any blood vessels.

The above examination and tests help confirm the diagnosis and assist to rule out conditions such as:

• Sebaceous cysts
• Abscess
• Cancerous growths
• Cysts (fluid-filled swellings)
• Any other non-cancerous (benign) growths

Typically a lipoma doesn’t cause any health issues. However, the indications of treatment include:

• cosmetic distress
• pain in the lipoma
• a rapid increase in the size of the swelling
• change in consistency of the swelling, i.e. it becomes hard or immovable
• becoming red or hot
• visible changes in the overlying skin

Based on the number, size and location of the lipomas, a treatment regimen can be determined by the doctor. Treatment involves two approaches

1. Medical management

This involves a non-surgical intervention in which steroidal injections are used. The steroid is injected into the lipomas, which causes the lipomas to shrink in size. However, this doesn’t completely eliminate the lipoma.

2. Surgical management

This is the preferred mode of intervention. It can be done in two methods:

• Surgical excision of the lipoma: in this method, the entire lipoma is removed (excised).
• Liposuction: it is a newer, costlier method that involves sucking out the contents of the lipoma (fat cells) using a special hollow tube. However, there is a risk of incomplete removal of all the fat cells leading to an increased chance of recurrence.

The procedures are typically daycare admissions (i.e., the patient is admitted in the morning and discharged by the evening).

(Read more: Lipoma removal surgery)

Many people can live with lipomas without even noticing them unless they are visible. Treatment is usually not required unless the patient requests it. After surgical treatment, there is a low risk of recurrence. However, lipomas can still develop in other areas of the body post-treatment.

Lipomas are non-cancerous swellings containing fat cells. They are a common occurrence in the population and do not pose any immediate health risk, hence, they do not require treatment. However, if there are any changes in the lipoma or if the patient finds it visually displeasing, the lipoma can be treated. The procedures of treatment are often daycare procedures. Surgical management is the preferred method of treatment. Recurrence post-treatment is rare.