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What causes them?
Lipomas are benign tumors made up of adipose or fatty tissue. They are very common. It is unclear what the true cause for a lipoma to develop is, however, genetics is thought to play a significant role. Often, people will note a family history of lipomas. There are also 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.
Can they be treated (shrunk or eliminated) without surgery?
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 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 potentially reduced risk of scarring.
If surgically removed, what’s the likelihood of them recurring?
The likelihood of a lipoma recurrence after surgical excision truly depends on whether the entire lipoma was removed based on how the lipoma was removed, whether it was encapsulated or well defined, and whether it had a deeper component that may have involved the fascia or muscle 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 they 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.
Of note, the lipomas associated with genetic syndromes to note:
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, 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.