Should I Be Concerned with Lipoma That Has Dry Texture?

Question

Have an 8 cm lipoma near my upper right shoulder. Have noticed a lot of tightness in my muscles near the area and the skin over the lipoma has a different texture (kind of dry) than the surrounding area.  Haven't seen a surgeon for removal.  Should I be concerned?

Raffy Karamanoukian, MD, FACS · Answer

Always err on the side of caution when dealing with a lump or lesion under the skin. Never assume that a lump is a lipoma without having an experienced surgeon examine the lesion and obtaining appropriate diagnostic studies.
Symptoms that should increase suspicion in a lump or bump under the skin:

Fast growth
Overlying skin changes
Nerve injury such as numbness or hypersensitivity, pain.
Multiple new lesions
History of cancer

This is not an exhaustive list but serves as a reference point for investigation.

Gregory Turowski, MD, PhD, FACS · Answer

I would strongly encourage you to see a specialist to determine that the skin growth you describe is a lipoma indeed. The experienced plastic surgeon should have no problem to recognize such, but often the pathology exam can give as the final diagnosis. It is recommended to remove lipomas, these types of fatty growths tend to get larger with time. The smaller the lipoma is, the smaller incision for the excision and the smaller scar afterwards. However, the skin change over the lipoma is unusual and should be evaluated by a specialist.

Otto Joseph Placik, MD · Answer

These are called "epaulette lipomas" because and epaulette is the shoulder decoration that a soldier or military officer wears.
The vast majority of these are benign but are removed for cosmetic reasons and to prevent further growth. Rarely, these may be malignant. The biopsy will be sent to evaluate this remote possibility.
In your instance, pain is not unuusal and can be a sign of stretching of the overlying nerves or pressure on the muscle.
The skin reaction does sound unusual.
Some surgeons use liposuction to remove this. Although it can reduce the size, it does not completely eliminate it and I generally do not use this technique unless the patient insists. Obviously, it would leave a smaller scar, but it does not make sense from a tumor treatement standpoint.
I hope this helps!

Steven H. Williams, MD · Answer

Lipoma is a diagnosis confirmed by pathology.  It is a very common benign tumor.  Soft tissue masses can be other things.  It is difficult to know for sure about the true nature of the lesion without a biopsy (usually excisional as opposed to incisional or needle (meaning that the goal would be to take the entire lesion out and submit it to pathology).
You should see a surgeon and have this lesion evaluated.
I hope this helps.

Daniel Reichner, MD, FACS · Answer

KDA
It would not be unusual to have slightly dry skin over the lipoma. I would recommend having the lipoma removed and examined by a pathologist to confirm that it is indeed a lipoma.

Pat Pazmino, MD, FACS · Answer

The texture of a lipoma is dependent on the quality of your skin as well as the size of the underlying lipoma. If the lipoma is large, it may stretch your skin and thus change the texture. Your best bet is to be evaluated by a board-certified plastic surgeon who will be able to determine if the lipoma is so large that it is affecting your function or appearance. They may recommend removal of the lipoma and will discuss with you the scarring and appearance afterwards.

Steven Wallach, MD · Answer

Although most mobile fatty like tumors under the skin are lipomas, until they are removed and the pathologist looks at the tissue, a final diagnosis can not be determined.

Hratch Karamanoukian, MD, FACS · Answer

The surgical literature states that lipomas larger than 5 cm can undergo malignant degeneration into liposarcoma - that is, the likelihood of developing liposarcoma or harboring liposarcoma is higher when the size exceeds 5 cm. So, it is recommended that you have it excised. if you are concerned about the cosmetic appearance, have a plastic/reconstructive surgeon available to plan the operation with the general surgeon or surgical oncologist who will remove it.

Hisham Seify, MD, PhD, FACS · Answer

In general, the diagnosis of a lipoma is a clinical one supported by pathological confirmation once removed. Unless you had it biposied, there is no way to know that this is a lipoma.Removal is always a good idea, the main issue is usualy the continued growth. Best of luck.

Arnold R. Oppenheim, MD (retired) · Answer

I, along with most physicians, are of the school of thought that growing soft tissue masses should be excised. Telling you to leave it alone is akin to not advising a patient to not stop smoking.  By waiting until this mass became 8 cms. you have already turned a ten minute, in office procedure into an outpatient process. Why wait longer? The earlier you go in the smaller the scar and the simpler the procedure. Are there any advantages to temporizing. I think not.
The textural changes on the skin  and symptoms you describe are quite worrisome. Most lipomas do not cause those type of changes to the skin. The symptoms of muscle tightness you mention are most likely due to the mass intertwining and infiltrating into the muscle tissue. At the very least, this will make it more difficult for the surgeon to remove your probable lipoma.
        Not all soft tissue masses of the back, that feel like lipomas are indeed lipomas. You might have a hibernoma. These are benign, rare tumors usually occurring in the area between the scapulae. It is named for its resemblance to the bronw fat of hibernating glands of animals, hence its name. 
      There are a number of varients to the simple lipoma including ones with fibrous tissue ( fibrolipoma); chondroid lipoma (cartilege like); myolipoma (muscle mixed in), spindle cell lipoma ( these are scary since they can look sarcomatous; and usually occurs in the shoulder region); pleomorphic lipoma  (again a shoulder lesion;) and an angiolipoma (these are usually painful and more in the domain of us dermatoloigsts so we see these on occasion.).
     What I, and my colleagues who have answered this question, worry about is the chance of this being a well-differentiated liposarcoma. These almost feel benign, and on casual inspection by the pathologist look benign. They have the chicken coop appearance of most benign lipomas until you look carefully and see the cells look a little larger  than they should. Also too numerous and a bit abnormal. This would be the tumor we would all be concerned about.
      I personally acted quite the opposite from you. My wife and I were watching St. Elsewhere one night and she asked me what's that lump on your shoulder. I said OMG, and within 30 minutes I was in the living room of a surgeon-friend. The next morning he was removing a rather gritty (not good) soft tissue mass. It was quite cellular. As a semi-pathologist I looked at the slides along with the hospital pathologist and it looked much more cellular than it should and there was even a mitosis or two (not good!). It was sent to the Armed Forces Institute of Pathology and they concluded it was benign. I just checked it now. Nothing there. So I suppose they were right (as usual). 
       But again, I see no advantage to waiting and would get this taken care of. Ask your family physician to recommend a good surgeon and have it removed. It will be most likely be a big relief.

Should I Be Concerned with Lipoma That Has Dry Texture?

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