Soft lump that can be an irritant

Is there a noticeable lump under the skin of your arms, shoulders, neck or waistline? If causing no pain, it could most probably be a Lipoma, a soft fatty benign (non-cancerous) growth made up of fat cells that clump together.

According to Consultant Plastic and Reconstructive Surgeon, Dr. Dulip Perera, the cause for the localized accumulation of fat that is well defined is unknown. "It is a common presentation in adults, though rare in children," he says adding that the stimulus for lipomas is acquired later on in life.

Lipomas under the skin are common: Dome shaped or soft and flat, Lipomas can develop anywhere although the most common sites are those mentioned above. They vary in size from pea size to several centimetres in diameter and are a cause for worry only when they become a cosmetic issue - looking unsightly or when garments don't fit sometimes causing discomfort.

However the painless, slow growing lumps often do not grow very big and very rarely become malignant in which case they are called Liposarcoma. Occasionally, Lipomas can be deep seated and would not be visible until their tip reaches the skin.

Need for proper diagnosis: Significantly, the non-hereditary condition should not be confused with obesity. "Neither weight loss nor diabetes control will affect their size," Dr. Perera warns, explaining that treatment should not be taken lightly. "The classical clinical presentation has to be diagnosed by a clinician," he adds as similar clinical conditions can occur for haemangioma (blood vessel tumour), neurofibroma (nerve tumour), sebaceous cysts or dermoid cysts which are more serious.

What are the symptoms of a lipoma and are they harmful?

Lipomas that cannot be prevented can occur as a single lump or multiple lumps. They are rarely congenital or familial. However, not all lipomas need treatment as most of them are small and are best left alone. Most people can live comfortably with them as they seldom warrant intervention. If a lipoma does not look too prominent or interfere with a person's normal routine such as in the way an individual dresses, it can be left alone.

Treatment: When a clinician decides that a lipoma should be treated, the treatment can be medical or surgical.

Medical: In recent times scientists have discovered a medical therapy that dissolves lipoma in a process called Mesotherapy, a multiple session treatment through injections. "Mesotherapy is an injection treatment for small localized lipoma, its basic principle being to dissolve lipoma and for the body to absorb it," Dr. Perera says. Though popular, the therapy is not widely accepted or practised owing to the cost and multiple sessions of treatment.

Surgical: When a clinician decides on surgery, the lipoma is surgically excised using local or general anaesthesia depending on the size of the lump and the age of the patient. It needs to be noted that incomplete surgical treatment may lead to early recurrence.

While small lipoma can be operated as a day case, large ones may require a day’s hospitalization, especially if the surgical procedure is done under general anaesthesia.

Liposuction is not commonly practised for the condition, the surgeon warns because the procedure is grossly incomplete for lipoma. "If treated this way, lipoma will reoccur in a short while," he says, clarifying that it is not a standard procedure for treatment of lipoma.