Lipoma management

Scope

  • In line with the Benign Skin and Subcutaneous Lesion Clinical Commissioning Policy for NHS Devon CCG 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.

Assessment

  • 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

Red Flags

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

Investigations

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.

Management

  • No intervention other than reassurance is required unless criteria for 2ww referral are met – see red flags.

Referral

In line with the Benign Skin and Subcutaneous Lesion Clinical Commissioning Policy for NHS Devon CCG 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-ccg.ifr-newsdt@nhs.net
  • Alternatively, please send to: The Panel administrator at Bridge House, Collett Way, Newton Abbot, TQ12 4PH

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

Suspected sarcoma 2ww

DRSS referral form

Supporting Information

Patient Information

MyHealth-Devon: Lipoma

Pathway Group

This guideline has been signed off on behalf of the NHS Devon Clinical Commissioning Group

Publication date: May 2019

 

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