Leg Lipoma Hurts, Should It Be Removed?

In my Los Angeles office, I see a lot of lipomas, a fraction of which are painful. Most lipomas are not symptomatic and I agree with Dr. Placik that the majority of painful lipomas are either angiolipomas or glomus tumors. I would have them surgically removed. In my practice, I use a very small incision overlying the lipoma.

If this lipoma is getting bigger, have it taken out. Removing the lipoma will likely make the pain subside, but not always. However, it should be removed in order to determine a pathological diagnosis.

The vast majority of lipomas are removed with local anesthesia.  Rarely, if there is an exceptionally large one, or if it's in a precarious location, sedation may accompany the local anesthesia.

Particularly if it hurts, I would recommend removal.

In my experience, the painful lipomas tend to be diagnosed as angiolipomas. Of course, that is of little relevance to you and has little to do with the treatmnent.
Lipomas are typically removed to establish a definitive diagnosis, minimize discomfort and prevent further growth. Generally, the surgical excision of lipomas in the extremities is relatively straighforward as long as they are not in close proximity to any significant nerves or vessels.
I have frequently performed these under local anesthesia and this should be an option if you can tolerate the injections. Other options include IV sedation or regional blocks. Discuss your fears and concerns with your surgeon.
Another option which is discussed but I don' t recommend is the use of liposuction for treatment of lipomas. It will clearly decrease the size, can be performed under local anesthesia, and uses small limited incisions. However, it never clearly completely removes the tumor and there is a higher risk of recurrence.

The removal of lipomas in the leg can be straightforward procedure. The most important point to keep in mind is that surgery in the lower extremities are prone to fluid collections. When discussing your surgery with your surgeon, ask what modalities they will use to prevent the accumulation of fluid, seromas, or hematomas. Your surgeon may recommend that you use tight compressive hose that will allow your skin to adhere to the underlying muscle.