Which medical specialty can perform lipoma removal?

Medical Specialties That Can Perform Lipoma Removal

Lipoma removal can be performed by multiple medical specialists including general surgeons, plastic surgeons, dermatologists, surgical oncologists, and pediatric surgeons, with the choice depending primarily on the lipoma's size, location, and complexity.

Appropriate Specialists Based on Lipoma Characteristics

For Simple/Routine Lipomas

• Dermatologists: Appropriate for small, superficial lipomas in cosmetically sensitive areas
• General Surgeons: Commonly perform lipoma excisions, especially for straightforward cases
• Family Physicians: May remove small, uncomplicated lipomas in office settings

For Complex Lipomas

• Surgical Oncologists: Preferred for large (>5 cm), deep, or atypical lipomas that require differentiation from liposarcomas 1
• Plastic Surgeons: Ideal for lipomas in cosmetically sensitive areas or those requiring reconstruction 1
• Pediatric Surgeons/Plastic Surgeons: For lipomas in children and adolescents 1

Decision Algorithm Based on Lipoma Characteristics

1. Small (<5 cm), superficial, typical lipomas:

   • Dermatologist or general surgeon
   • Office-based procedure under local anesthesia

2. Large (>5 cm) or deep lipomas:

   • Surgical oncologist or general surgeon with sarcoma experience 1
   • Consider preoperative imaging and possibly biopsy

3. Lipomas in cosmetically sensitive areas (face, neck, exposed areas):

   • Plastic surgeon or dermatologist with cosmetic expertise 1
   • Minimally invasive techniques may be considered 2

4. Pediatric lipomas:

   • Pediatric surgeon or pediatric plastic surgeon 1

5. Atypical lipomatous tumors (ALT/well-differentiated liposarcoma):

   • Surgical oncologist or sarcoma specialist 1, 3
   • Should be managed within a multidisciplinary team

Important Considerations

When to Refer to a Specialist Sarcoma Center

• Lipomas >5 cm in diameter
• Deep-seated lipomas (beneath the fascia)
• Rapid growth or pain in a lipomatous mass
• Atypical imaging features suggesting possible ALT/liposarcoma 1, 3

Surgical Approaches

• Standard surgical excision with negative margins is the most common approach 3
• Minimally invasive techniques like liposuction may be used for larger lipomas in cosmetically sensitive areas 2, 4
• Combined approaches (liposuction with limited excision) may be appropriate in select cases 4

Common Pitfalls to Avoid

1. Misdiagnosis: Failing to distinguish between simple lipomas and atypical lipomatous tumors, which require different management approaches 1, 3

2. Inadequate Margins: Incomplete excision leading to recurrence, particularly with atypical lipomatous tumors 1

3. Inappropriate Specialist Selection: Choosing a provider without appropriate experience for complex cases

4. Overlooking Malignancy: Rarely, what appears to be a lipoma may be a well-differentiated liposarcoma, particularly for large, deep tumors 5

In summary, while multiple specialties can perform lipoma removal, the choice of specialist should be guided by the lipoma's characteristics, location, and complexity, with more complex cases warranting referral to specialists with appropriate surgical oncology expertise.