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Lipoma Treatment Evolves: Understanding the New Treatment Options for Lipoma

A lipoma is a benign soft tissue tumor that is commonly found just below the skin on the back, trunk, arms, shoulders, and neck. It is a slow-growing, painless lump made of fat that moves easily when touched and feels doughy or rubbery, not hard. Lipomas are usually detected in middle age and are typically less than 2 inches in diameter, but they can grow. They are not cancerous and usually harmless, but they may cause complications if they are large or compress nearby structures and nerves.

This blog talks about Types of Lipomas and their treatment options:

Types of Lipomas
It is important to distinguish between different types of Lipomas and to be aware of their potential implications.

Adipose lipomas
Adipose lipomas are benign tumors composed of adipose (fat) cells, often encapsulated by a thin layer of fibrous tissue. They are the most common type of subcutaneous tumor and can occur anywhere in the body, but are most commonly found on the neck, shoulders, back, abdomen, arms, and thighs. Lipomas are usually slow-growing, soft, doughy, and painless, and can be diagnosed with a physical exam. Treatment is generally not necessary, but if the lipoma is bothersome, painful, or growing, it can be removed surgically or with liposuction. Lipomas are not to be confused with adiposis dolorosa, a rare condition characterized by painful folds of fatty tissue or lipomas that can occur anywhere on the body but are most often found on the buttocks and upper parts of the arms and legs.

Fibrous lipomas
Fibrous lipomas are a subtype of lipomas, which are benign tumors composed of adipose (fat) cells, often encapsulated by a thin layer of fibrous tissue. Fibrous lipomas contain more fibrous tissue than conventional lipomas and can be found anywhere in the body, but are most commonly found on the upper back, neck, and shoulders. They are usually slow-growing, soft, doughy, and painless, and can be diagnosed with a physical exam. Treatment is generally not necessary, but if the lipoma is bothersome, painful, or growing, it can be removed surgically or with liposuction.

Myxoid lipomas
Myxoid lipomas are a rare variant of lipomas, which are benign tumors composed of adipose (fat) cells. Myxoid lipomas can occur in various parts of the body, including the oral soft tissue, where they are considered an unusual histologic type of lipoma. These tumors are characterized by their myxoid appearance, which is a result of the presence of intercellular mucoid material and lipid globules of variable sizes within the cytoplasm of the tumor cells.

Spindle cell lipomas
Spindle cell lipomas are rare, benign tumors composed of mature adipocytes (fat cells) and small, uniform spindle cells. They are typically found in the subcutaneous layer of the posterior trunk, shoulder, and posterior neck, and are most common in men between the ages of 40 to 60. These tumors are characterized by their myxoid appearance, containing spindle cells that are longer than they are wide. Spindle cell lipomas are noncancerous and usually do not require treatment unless they are painful, growing large, or bothersome. In such cases, the recommended treatment is surgical removal.

Pleomorphic lipomas
Pleomorphic lipomas are relatively uncommon benign adipocytic tumors that display a variable lipomatous component, spindle-shaped cell component, and floret-like giant cells with nuclear pleomorphism. They were first described in 1981 and are reported to be more common in the age group of 50-70 years, with only 10% of tumors occurring in females. These tumors are characterized by an intimate admixture of variable-sized fat cells, spindle cells, and bizarre, pleomorphic, multinucleated giant cells, with many of the giant cells showing a distinctive floret-like arrangement of the nuclei. The diagnosis of pleomorphic lipomas is based on histological examination, which may show a circumscribed fatty tumor with mature fat admixed with more cellular areas, mucinous and spindled areas, and intermixed lipoblast-like cells, which are giant, multinucleated, and often referred to as floret giant cells.

Diagnosis
1. Slow-growing, painless lump under the skin
2. Soft and doughy to the touch, with a rubbery texture
3. Moves easily with slight finger pressure
4. Typically less than 2 inches (5 centimeters) in diameter, but can grow larger
5. Sometimes painful if they grow and press on nearby nerves or contain many blood vessels

Lipomas can be diagnosed with a physical exam, but in some cases, imaging techniques such as ultrasound, CT scan, or MRI scan may be used to provide a clearer picture. In cases where the diagnosis is uncertain, a biopsy may be necessary to confirm the diagnosis. Treatment for lipomas is usually not necessary, but if the lipoma is bothersome, painful, or growing, it can be removed surgically or with liposuction.

New treatment for lipoma
Non-surgical treatments for lipomas are limited, and there are no non-invasive treatment modalities that can remove a lipoma. Steroid injections may be used to shrink or remove smaller lipomas by stimulating the breakdown of fatty tissue and encouraging fat loss in the area. Injection lipolysis or Lipodissolve is a technique for dissolving fat for non-surgical body contouring, but its use as a treatment modality for lipomas needs further evaluation. Watchful waiting may be appropriate for small or slow-growing lipomas that are not bothersome or painful. Surgical treatments for lipomas include surgical excision (removal) and lipoma removal through incision or liposuction.

The surgical procedure involves marking the area on the body, injecting the local anesthetic, making an incision appropriate for the size and shape of the lipoma, using a gloved finger or blunt scissors to free the lipoma from the surrounding tissue, and closing up the incision. Post-treatment care involves monitoring for complications such as infection, bleeding, pain, scarring, or recurrence, and follow-up appointments with a healthcare provider. Surveillance after tumor removal usually involves physical exams and imaging every 6 to 12 months.

The Bottom Line
Consulting with healthcare professionals for personalized advice is crucial, as they can provide tailored recommendations based on the specific characteristics of the lipoma and the individual’s medical history. While non-invasive treatment modalities for the removal of a lipoma are limited, advancements in surgical techniques, such as endoscopic removal, may offer less invasive options for certain cases, particularly for cosmetic reasons. It’s important to discuss the most suitable lipoma treatment approach with a healthcare provider.





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