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Lipoma
The soft lump that slips under the fingers: when to observe and when to remove.
A lipoma is a collection of fatty tissue enclosed in a capsule, sitting beneath the skin. It is benign, common, and in most cases requires nothing more than knowing what it is. It presents as a soft, yielding swelling that slides sideways when pushed, with the overlying skin perfectly normal and free to move.
Typical sites are the trunk, shoulders, neck, arms and thighs. It grows very slowly — patients often say they have had it «forever» — and does not hurt: when it does, it is usually because it presses on a nearby structure or sits where pressure is applied, such as under a belt or a bag strap.
The useful part here is not the description of the typical picture, but its opposite. A lump that is hard rather than soft, fixed rather than mobile, that grows over weeks rather than years, or that reaches a substantial size, should not be assumed to be a lipoma merely because it lies under the skin. These are precisely the features for which assessment is not postponed — not because they indicate something serious, but because they are not the expected ones.
The decision to remove, when the picture is typical, is therefore largely the patient's: it is removed if it grows, if it hurts, if its site makes it a nuisance, or if it is cosmetically bothersome. What is not optional is histological examination of what is removed: it is the only thing that turns a clinical hypothesis into an answer.
Soft and mobile is the expected picture: hard, fixed or fast is not
A typical lipoma is easy to recognise and reassuring precisely because its features are consistent. The point of the visit is not to confirm those features when they are present, but to notice when they are absent. A swelling that is hard, fixed to the deeper planes, painful on its own, or grown within a few weeks does not behave like a lipoma, and in that case the label goes on after assessment, not before. It is the one part of this subject where waiting is not advisable.
How it shows
- A soft, yielding lump under the skin that slides when pushed sideways
- Normal overlying skin, moving freely over the lesion
- Very slow growth, often present for years
- No pain, except when it compresses nearby structures
- Frequent sites: trunk, shoulders, neck, arms, thighs
- Possible presence of several lipomas in the same person
How we proceed
- 1Dermatological visit: consistency, mobility, relationship to the deeper planes
- 2Check that the picture matches what is expected of a lipoma
- 3Shared decision on observation or removal, based on symptoms and site
- 4Outpatient removal under local anaesthetic, where indicated
- 5Histological examination and review of healing
Available treatments
- Dermatology visit
- Outpatient removal
- Histological examination
- Post-operative follow-up
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Frequently asked questions
Can a lipoma become malignant?+
A lipoma is a benign lesion and is not a precursor of anything else. The point of assessment is not to keep watch on a lipoma for fear it will transform, but to be certain from the outset that the swelling really is a lipoma: other subcutaneous lesions can resemble one at first touch, and are distinguished by consistency, mobility and rate of growth. It is the initial diagnosis that matters, not surveillance over time.
Can it be removed without a scar?+
No: removing the lesion with its capsule requires an incision, so a scar always remains. Its extent depends on the size of the lipoma and the site. When the reason for removal is purely cosmetic it is worth weighing this honestly beforehand, because on small, barely visible lesions the result can simply be a trade: the lump goes, the mark stays.
I have more than one: is that a problem?+
Having several lipomas is fairly common and does not change the benign nature of the individual lesions. In some people the tendency to develop several runs in the family. What is done at the visit is to assess them as a group: check that they all have the expected characteristics and decide together whether and which are worth removing — usually those in awkward positions or those that have grown recently.
Is the procedure painful?+
The procedure is done under local anaesthetic: you feel the initial injection of the anaesthetic and then pressure or traction, not pain. In the following hours some discomfort at the site is normal and manageable with ordinary painkillers. The appointment is longer than a visit because it includes the procedure, and you go home straight afterwards.
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