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Dermatologic Manifestations of Lipomas Clinical Presentation

  • Author: Robert A Moraru, MD; Chief Editor: William D James, MD  more...
 
Updated: Nov 12, 2014
 

History

Patients usually give a history of a slowly growing lesion present for several years and usually do not complain of discomfort. Lipomas are classified in the categories described below.

Solitary lipomas (most common)

Most solitary lipomas are superficial and small. Solitary lipomas may develop with weight gain but usually do not shrink after weight loss.

Diffuse congenital lipomatosis

Diffuse, poorly demarcated lipomas localized primarily on the trunk characterize this type, as shown in the image below.

A 43-year-old white man with a 3- to 4-year histor A 43-year-old white man with a 3- to 4-year history of a slow-growing asymptomatic growth on his right shoulder.

Tumors often infiltrate through muscle fibers, making them resistant to surgical removal. These tumors are composed of immature fat cells.

Benign symmetric lipomatosis (Madelung disease) [2, 3, 4]

Madelung described the condition in 1888. Lipomas of the head, neck, shoulders, and proximal upper extremities characterize this condition. Men are affected 4 times as often as women. The patient's history often includes excessive alcohol consumption or diabetes.

Other conditions associated with Madelung disease include malignant tumors of the upper airways, hyperuricemia, obesity, renal tubular acidosis, peripheral neuropathy, and liver disease.

Familial multiple lipomatosis

This clinical entity is characterized by few-to-many, small, well-demarcated, encapsulated lipomas that commonly involve the extremities. Typically, this form appears during or soon after adolescence. The neck and shoulders usually are spared (unlike benign symmetric lipomatosis). A family history of multiple lipomas usually exists, and an autosomal dominant mode of inheritance is found.

Dercum disease (adiposis dolorosa) [5, 6, 7, 8]

Painful lipomas are the hallmark of this rare condition. Lipomas typically occur on the extremities of obese postmenopausal women. Alcoholism, emotional instability, and depression commonly are associated with Dercum disease.

Angiolipomas

Typically, these tender, soft, subcutaneous nodules are present in adolescence. Tumors frequently are multilobulated and are somewhat firmer than ordinary lipomas. The associated pain is vague and may be spontaneous or caused by pressure.

Hibernomas

Tumors are solitary well-circumscribed nodules that typically are asymptomatic. Usually, tumors are located in the interscapular region, axillae, neck, or mediastinum. Histologically, hibernomas are composed of embryonic brown lipoblasts termed mulberry cells because of their appearance.

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Physical

Lipomas present as subcutaneous nodules of 2-10 cm. Lipomas often are lobulated. Consistency is rubbery. Skin overlying the lesion is normal and is not connected to the tumor. Neck, back, and proximal extremities are affected most commonly.

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Contributor Information and Disclosures
Author

Robert A Moraru, MD Staff Physician, Department of Dermatology, St Luke's/Roosevelt Hospital Center, Columbia Presbyterian Medical Center

Robert A Moraru, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Rosalie Elenitsas, MD Herman Beerman Professor of Dermatology, University of Pennsylvania School of Medicine; Director, Penn Cutaneous Pathology Services, Department of Dermatology, University of Pennsylvania Health System

Rosalie Elenitsas, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society of Dermatopathology, Pennsylvania Academy of Dermatology

Disclosure: Received royalty from Lippincott Williams Wilkins for textbook editor.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Janet Fairley, MD Professor and Head, Department of Dermatology, University of Iowa, Roy J and Lucille A Carver College of Medicine

Janet Fairley, MD is a member of the following medical societies: American Academy of Dermatology, American Federation for Medical Research, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

References
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A 43-year-old white man with a 3- to 4-year history of a slow-growing asymptomatic growth on his right shoulder.
A 43-year-old man with a slow-growing asymptomatic growth.
Surgical excision of a 6-cm lipoma on the back of a 54-year-old man using the squeeze technique.
 
 
 
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