Should I remove a Lipoma? I'm afraid of the (rare) chance that it might be a Liposarcoma.

Lipomas are benign fatty tumors that occur under the skin and less commonly within the muscle. They are associated with mild discomfort and a lump underneath the skin. It is always best to talk to an expert plastic surgeon to determine whether the lipoma is possibly a cyst or a tumor or hernia. We would have to remove the lipoma to be sure that it is not something else and we usually do this by sending it to a pathologist for evaluation. If a lipoma is painful, then an exam is needed to make sure it is not compressing on a nerve or whether the diagnosis is different. Aftercare for a lipoma includes gentle compression and Plato’s Scar Serum twice daily on the wound.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Removal of a lipoma is a very common procedure.  If you have had your lipoma for several years and it is not getting bigger, it is unlikely that it would be a liposarcoma.  If the lipoma is bothering you, I would recommend that you have it removed.  It can be biopsied after removal and you could find out definitively what it is.  In many cases, lipomas can be removed in the office with just local anesthesia.  

Thank you for sharing your question. Your concerns are normal. If you have had your lipoma for years and you have not noticed any significant changes, it is unlikely that it would be a liposarcoma. However, i would still advise to have it removed and sent to a pathologist for evaluation. Be sure to see a board certified plastic surgeon for best esthetic results. 

You raise some very important points that should be considered when someone presents with a soft tissue mass of fatty origin.  A lipoma is a non-cancerous tumor that arises from replication of fat cells.  This can occur anywhere in your body that you have fat cells, and some patients are prone to making multiple lipomas.  Usually lipomas are soft, mobile, have well-circumscribed (smooth, round) edges, and are slow-growing.  Fatty tumors can also be cancerous, in which case they are called liposarcomas.  Liposarcomas are often hard, fixed to surrounding structures, have poorly defined edges, and are rapidly growing.  If the mass is small, it is even more likely to be a lipoma rather than a liposarcoma; however, giant lipomas do exist.  Lipomas can also be intramuscular (embedded within a surrounding muscle), and thus not very mobile.  The absence or presence of a single one of these features does not make or rule out the diagnosis of lipoma or liposarcoma.  The entire clinical scenario must be assessed before a diagnosis is reached.  When the diagnosis is uncertain based on physical examination, imaging such as an ultrasound or MRI can be performed to look for changes in density in the lesion that could suggest cancer.  When a liposarcoma is strongly suggested, a biopsy can be performed where a piece of tissue is removed and sent to the lab to be evaluated under a microscope for the presence of malignant cells.  A lipoma that has no concern for cancer does not need to be removed; however, if the lipoma is bothersome to the patient in regard to discomfort or appearance, it is reasonable to remove it.  If there are changes that suggest a lipoma could become cancerous or symptomatic such as increase in size, it is best to have it removed.  The drawback of removal of a lipoma is the presence of a linear scar in its place.  For some patients with small lipomas, the scar may not be worth it.  However, in other patients with large lipomas, a fine-line scar may be worth the improved contour.  When asymptomatic and no concerns for malignancy, these decisions regarding removal are based mainly on patient preference.
Ziyad Hammoudeh, MD

Lipomas are very common benign tumours of fat. Liposarcomas are rare. Some people have many lipomas others may only make one. Benign lipomas are usually small soft and painless. They are usually not growing. The reason a doctor may advise you not to remove it is that they consider it to be an unnecessary procedure. Any operation will leave a scar and there is the potential for complications such as bleeding, infection and slow healing which may be inconvenient. There is also the cost.If a lipoma is showing concerning features, such as growth, pain or large size, then it should be removed for biopsy.You are advise to consult and take the advice of a trained and experienced doctor.