A lipoma is a benign, fatty tumor that forms just beneath the skin. These nodules are usually painless, but they can cause cosmetic concern or discomfort if they press on nearby nerves. Any lump under the skin warrants medical assessment to ensure it is not a more serious condition, such as a liposarcoma, a malignant tumor of fat cells. Understanding the medical journey, from initial diagnosis to potential removal, involves several different specialists.
Starting the Journey: Primary Care and Dermatology
The first step in assessing any new lump or growth is a consultation with a Primary Care Physician (PCP). The PCP conducts a physical examination, feeling the lump to check its consistency, mobility, and size, and takes a detailed medical history. A lipoma typically feels soft, is easily moved under the skin, and is generally less than two inches (5 cm) in diameter.
In many straightforward cases, a PCP can confidently diagnose a superficial lipoma based on this clinical assessment alone and may recommend simply observing the growth. If the lump is small and presents typical characteristics, the PCP may refer the patient directly to a specialist for removal if requested, or if the lipoma is causing symptoms. If the diagnosis is uncertain, or if the patient prefers a skin specialist, the PCP will refer to a Dermatologist.
Dermatologists specialize in conditions of the skin, hair, and nails. Their expertise allows them to distinguish a lipoma from other common skin lumps, like epidermoid cysts, which are firmer. Dermatologists frequently manage smaller, easily accessible lipomas, from initial diagnosis to in-office removal. If the lump is large, deep, or displays atypical features like rapid growth or pain, a referral to a Radiologist for further testing will be the next step.
Confirming the Diagnosis: The Role of Medical Imaging
If a physical examination leaves any doubt about the nature of the lump, or if the growth is particularly large, deep, or fixed to underlying tissue, medical imaging is necessary. The specialist overseeing this diagnostic process is the Radiologist, who interprets the resulting images. The most common first-line imaging tool for a suspected lipoma is an ultrasound.
Ultrasound uses sound waves to provide real-time visualization. A typical lipoma appears on ultrasound as a well-defined, oval-shaped mass with a characteristic fatty texture, often with minimal blood flow. If the lipoma is deep or if there is any suspicion of malignancy, a Magnetic Resonance Imaging (MRI) scan may be ordered. MRI provides a more detailed, high-resolution view of the lipoma’s relationship to surrounding structures like muscle and nerves.
Surgical Removal: Choosing the Right Specialist
The decision to remove a lipoma is usually made if it is causing pain, growing rapidly, presenting a cosmetic concern, or if the diagnosis remains uncertain and a biopsy is needed. The type of specialist chosen for removal depends mainly on the lipoma’s size, depth, and location.
Dermatologic Surgeon
For smaller, superficial growths, a Dermatologic Surgeon often handles the excision in an outpatient setting using local anesthesia. These specialists are skilled in minor surgical procedures and focus on aesthetic outcomes for skin-level lesions.
General Surgeon
If the lipoma is large, located deep within the tissue, or situated in a complex anatomical area like the neck or trunk, a General Surgeon is typically the best choice. General Surgeons are trained to manage more complex excisions that may require deeper dissection and potentially different anesthesia options.
Plastic Surgeon
A Plastic Surgeon is frequently recommended when the lipoma is on a cosmetically sensitive area, such as the face or hands. These surgeons specialize in minimizing scarring and optimizing the aesthetic result. They may also utilize techniques like liposuction for larger lipomas. The initial physician will guide the patient to the most appropriate surgical specialist based on the specific characteristics of the lipoma and the patient’s priorities.