Lipoma vs Liposarcoma: What is it and how to manage it?

Lipoma are soft-tissue tumors that are slow growing, benign lobulated masses in a fibrous capsule consisting of lipids. They can occur singly or multiple. There is a debate that there is a genetic link towards developing multiple lipomas and an autosomal dominant pattern has been observed.

How do they present clinically?

Lipomas of the skin are mostly asymptomatic swellings. Sometimes they can be painful if appear on the nerves. We can do a “slippage sign” by gently sliding the fingers off the tumor edge. If the tumor slids out it’s most likely a lipoma if not ddx would include sebaceous cyst or abscess (Nickloes 2017).

Most commonly they occur at shoulder, neck, trunk and arms. In Decrum disease lipomas may present as painful entities.

When should we raise the hypothesis of liposarcoma?

Liposarcomas rarely happens in skin. It is often deep seated tumor and most often grows on thighs and back of the peritoneum. If any lipoma is rapidly enlarging and/or suddenly becomes painful it should raise the suspicion of being a liposarcoma.

Management:

Mostly they don’t require any treatment and are self-limiting. Some may even stop growing and some may stay there indefinitely.

Simple surgical excision is the gold standard.

Liposuction can also be offered in some cases(Ngan 2017).

References:

Ngan 2017. Lipoma and liposarcoma | DermNet New Zealand. Available at: https://www.dermnetnz.org/topics/lipoma-and-liposarcoma/.

Nickloes 2017. Lipomas: Background, Pathophysiology, Etiology. Available at: https://emedicine.medscape.com/article/191233-overview#showall.