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Referral
Lipoma management
Scope
- In line with the Benign Skin and Subcutaneous Lesion Clinical Commissioning Policy for NHS Devon the assessment or excision of lipomata is not routinely commissioned in Devon or Cornwall
- Lipomata are benign growths of adipose tissue
- Lipomas are common, affecting about one in 100 people
- Diagnosis is usually clinical – ultrasound scan is not required to confirm the diagnosis and is unreliable as a means of excluding sarcoma
- Individual funding requests can be made for cases of exceptional clinical need
- Lipoma size has been removed as a red flag as it is no longer considered a reliable indicator of the risk of malignancy
Out of Scope
Suspected sarcoma
A National workstream is currently underway and is looking to produce updated criteria to help GPs assess the risk for sarcoma
In the meantime please use the following red flags and if any are present consider a 2ww sarcoma referral:
- Significant persistent pain that is not solely pressure related
- Rapid growth over a short period of time
- Deep fixity to muscle or facia
- Prior malignancy – other than Basal Cell Carcinoma.
- Harmless soft "doughy" lumps
- Range from pea sized to several centimeters
- Grow very slowly and don't usually cause any other problems
- Can occur anywhere where there are fat cells, but are usually seen on the:
- shoulders
- neck
- chest
- arms
- back
- buttock
- thigh
It is unusual to develop more than one or two lipomas Familial multiple lipomatosis – rare - causes lipomas to develop all over the body
Lipoma or cyst?
A cyst is a fluid filled sac under the skin and can look like a lipoma
Here is how to tell the difference:
- cysts are close to the skin surface, whereas lipomas are deeper
- cysts are firm or fluctuant, whereas lipomas are soft, mobile and dough-like
- with certain cysts, the skin may be inflamed but it isn't with lipomas
The following are the current criteria for considering a 2ww sarcoma referral:
- Significant persistent pain that is not solely pressure related
- Rapid growth over a short period of time
- Deep fixity to muscle or facia
- Prior malignancy – other than Basal Cell Carcinoma
No investigations are required unless other criteria for 2ww referral are met – see red flags.
If there is a high clinical suspicion of sarcoma, (see red flags) please refer via the 2ww pathway for suspected sarcoma.
- No intervention other than reassurance is required unless criteria for 2ww referral are met – see red flags.
In line with the Benign Skin and Subcutaneous Lesion Clinical Commissioning Policy for NHS Devon the assessment or excision of lipomata is not routinely commissioned in Devon or Cornwall
Suspected sarcomas should be sent as 2ww referrals.
All other lipoma referrals will be returned to the practice.
Should you believe your patient meets the exceptional funding criteria the referral will need to be sent for consideration of funding approval with full details and supporting photographs. Individual cases will be reviewed by the appropriate panel of the CCG upon receipt of a completed application from the patient's GP, consultant or clinician. Applications cannot be considered from patients personally.
Applications for consideration for funding approval should be sent to:
- Email: d-icb.ifr-newsdt@nhs.net
Referral Criteria
Minimum information needed is:
- Speed of growth
- Symptoms
- Site
- Consistency
- Size
Referral Instructions
e-Referral Service Selection:
- Specialty: 2WW
- Clinic Type: 2WW Sarcoma
- Service: Two week Wait Sarcoma-RDE-RH8
Referral Forms
Patient Information
Pathway Group
This guideline has been signed off on behalf of NHS Devon.
Publication date: May 2019
