Dermatologic Manifestations of Lipomas Clinical Presentation

  • Author: Robert A Moraru, MD; Chief Editor: William D James, MD   more...
 
Updated: Jan 12, 2012
 

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 following categories:

  • 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 historA 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]
    • 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)[4, 5, 6]
    • 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

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 Dermatological Association, American Federation for Medical Research, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

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

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

Disclosure: Nothing to disclose.

Rosalie Elenitsas, MD  Herman Beerman Associate 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 and American Society of Dermatopathology

Disclosure: Lippincott Williams Wilkins Royalty Textbook editor; DLA Piper Consulting fee Consulting

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

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 and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

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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