Lipoma — a soft lump under the skin. When to remove it and when to observe it

A soft, mobile lump under the skin — on the forearm, the neck, the back or the thigh. It does not hurt, it shifts slightly under your finger, it grows very slowly or not at all. Most people discover it by accident and for a while pretend it is not there.

It is most often a lipoma — and the good news is that usually there really is nothing you need to do about it. But not always.

What a lipoma is

A lipoma is a benign tumour built of mature fat cells, surrounded by a thin capsule. It is one of the most common subcutaneous lesions in adults. A typical lipoma is soft, elastic, clearly demarcated and mobile against the underlying tissue — an important feature that distinguishes it from lesions that give cause for concern.

Where does it come from? It is not entirely clear; a family predisposition plays a role. In some people lipomas occur in large numbers.

If there are many lipomas — a dozen or more, especially on the arms and the thighs, and especially if parents or siblings had similar lesions — it is worth telling the doctor. Multiple lipomas can run in families, and if they additionally hurt when touched, they call for separate investigation. This does not change the benign nature of the lesions themselves, but it does change the plan: with multiple lipomas we do not excise all of them, only those that actually get in the way.

When observation is enough and when to see a doctor

A small, soft, non-growing lipoma in an inconspicuous place can simply be observed. A consultation is needed, however, for a lesion that:

• is growing — especially quickly,
• is hard or immobile,
• hurts or presses on a nerve (numbness, tingling),
• has appeared deep, e.g. on the neck, and its borders are hard to assess,
• is simply a nuisance — aesthetically or mechanically (a belt, a strap, the back of a chair).

A hard or fast-growing lump does not have to be anything dangerous — but it should be a doctor who settles that, not guesswork. The assessment takes a few minutes.

Three features that will make the doctor order imaging before we even talk about excision: a lesion lying deep, under the fascia (it cannot be moved together with the skin), a diameter over 5 centimetres and rapid growth. Ultrasound is enough in most cases, sometimes an MRI is needed. This is not over-caution — excising such a lesion without a diagnosis can make further treatment harder if it turns out that it was not a lipoma.

How a lipoma is removed

Ointments, massage or "breaking it up" do not work — a lipoma has a capsule and a structure of its own that no cream will dissolve.

What is effective is surgical enucleation of the whole lesion together with its capsule — under local anaesthesia, through a small incision made along the skin tension lines so that the scar is as inconspicuous as possible. A lipoma removed in its entirety, together with its capsule, usually does not grow back; recurrences are rare and happen most often when, with a lesion fused to the surrounding tissue, it was not possible to remove the whole capsule. The material can at the same time be sent for histopathological examination — giving you a certain diagnosis.

What comes after the procedure. You keep the wound dry for the first two days; we remove the stitches after several days to a couple of weeks, depending on the site. You usually go back to desk work straight away, but with lifting, the gym, the swimming pool and the sauna, wait until the stitches come out — especially when the lesion was on the back, the shoulder or the thigh, where the skin works with every movement. Come in sooner if the area around the wound becomes hot, markedly red, swollen, or if discharge appears.

The procedure usually takes 20–45 minutes and ends with a few stitches; you go back to desk work straight away, but with physical exertion wait until the stitches are removed, for which you come in a few days later.

How much it costs

How to tell a lipoma from a sebaceous cyst — because the question comes up in the clinic regularly. A sebaceous cyst lies more superficially, is more attached to the skin and very often has a tiny dark dot at the top, that is, its opening. It can become inflamed: turn red, become painful, and under pressure content with an unpleasant smell comes out of it. A lipoma lies deeper, moves under the skin and has no opening. This distinction matters in practice, because a sebaceous cyst has to be excised together with the whole capsule and that opening — otherwise it grows back.

Surgical excision of the lesion costs from 1000 zł — the exact quote depends on the size and the location, and is preceded by a consultation. You will find the details of the procedure on the page about surgical removal of skin lesions. If you are not sure whether your lump is a lipoma or a sebaceous cyst — all the more reason to start with a consultation.