What is a lipoma?

A lipoma is a benign tumour of the fatty tissue that appears as a lump under the skin. In most cases, lipomas occur under the skin (subcutaneously) on the soft tissues and particularly frequently affect the neck and head area. In addition to subcutaneous lipomas, there are also deep-seated or infiltrating lipomas, which occur more rarely and have little clinical relevance. Lipomas are often diagnosed as an incidental finding by an imaging procedure and often do not require therapy, but they can disturb the aesthetic sensation. Lipomas develop more frequently than average after the age of 40 and rarely affect children. Men suffer from the disease more often than women.

What are the different types of lipomas?

Doctors distinguish between the following types of lipomas:

• subcutaneous lipoma: is the most common form of lipoma and is located just under the skin. A subcutaneous lipoma can be felt externally as a round or oval lump. In rare cases, subcutaneous lipomas can also grow into the muscles or affect the area of the lumbar spine and/or sacrum.
• subfascial lipoma: lies under a layer of connective tissue (fascia) which is enveloped by muscle. A subfascial lipoma most often occurs on the head and grows at the transition from the forehead to the hair. A subfascial lipoma can also develop in the area of the neck or shoulder blade.
• Angiolipoma: is a special type of lipoma and consists of blood vessels that are often blocked (thrombosed). An angiolipoma, which causes pain, affects men more often than average. If an angiolipoma develops in women, several angiolipomas usually occur at the same time.
• Spindle cell lipoma: is another special type of lipoma and mainly affects men between the ages of 45 and 60. A spindle cell lipoma often develops on the back, neck or shoulder and usually does not cause any discomfort.

The growth of a lipoma is rather slow and often only reaches a size of a few centimetres. In exceptional cases, however, a lipoma can grow to a diameter of more than ten centimetres. This is called a giant lipoma.

How do lipomas develop?

The exact causes of lipomas are not yet known. However, doctors assume that lipomas can form due to an unusual development of pluripotent mesenchymal cells. It is also conceivable that lipomas develop as a result of an increase in cells (hyperplasia), i.e. an enlargement of tissue. It is also possible that lipomas appear as neoplasia, i.e. as a new formation of tissue.

Is a lipoma dangerous?

A lipoma carries only a small risk of developing into a malignant tumour. Although the lipoma does not disappear on its own, it does not require treatment unless it is aesthetically disturbing. But even after surgical removal, a lipoma can form again.

What symptoms does a lipoma cause?

In most cases, a lipoma does not cause any symptoms. The lipoma is only noticed as a lump under the skin that feels bulging and rubbery. A lipoma is easy to move and only causes pain when pressure is applied to it. Depending on the location of the lipoma, this can also be the case through regular movements. If it is a rather rare angiolipoma, it can also hurt without external influences.

How is a lipoma diagnosed?

It is always advisable to have a lump that can be felt under the skin examined by a doctor. This is the only way to rule out a malignant tumour. During the examination, the doctor will first palpate the lump and check whether it can be moved easily and stands out from the adjacent tissue. Following this examination, the lump is examined more closely using imaging techniques. An ultrasound examination (sonography) or an X-ray examination can be used for this purpose. These imaging methods not only allow the doctor to determine the size of the lipoma. In some cases, it is also possible to distinguish the lipoma from a cyst or other skin neoplasm, such as a fibroma. If there is still uncertainty about the type of lump, a tissue sample can be taken and a biopsy can be taken to determine which disease is present.

How are lipomas treated?

Lipomas do not always need to be treated. A lipoma only needs to be surgically removed if it is causing physical discomfort due to its size. However, the removal of a lipoma is usually desired by the affected person for aesthetic reasons. As long as it is not too large or in an unfavourable location, the operation can be performed under local anaesthesia.

What complications can arise from the removal of a lipoma?

In general, the surgical removal of a lipoma carries few risks. However, asymmetries, hardening of the tissue or dents may occur and the operation may therefore not meet the patient's expectations. Bruising, secondary bleeding or swelling is possible after the surgical procedure. In some cases, fluid may even accumulate on the wound surface, a feeling of numbness may develop or there may be sensitivity to touch. These symptoms are usually temporary.

Can a lipoma be prevented?

The exact causes of lipoma are still largely unknown. Therefore, there are still no special measures to prevent the development of a lipoma. In any case, it is advisable to have a balanced lifestyle, avoid nicotine, drink enough fluids every day and get plenty of exercise.