Is a referral to a general surgeon (GS) acceptable for the management of a lipoma?

Referral to General Surgeon for Lipoma Management

Yes, referral to a general surgeon is acceptable for standard lipoma excision, provided the lesion meets criteria for a typical benign lipoma (superficial, <5 cm, slow-growing, and without concerning features). 1

When General Surgeon Referral is Appropriate

For typical benign lipomas, general surgeons with specific training in soft tissue tumor removal can safely perform standard excisions 1. This applies when the lipoma demonstrates:

• Superficial location with characteristic soft, mobile consistency 2
• Size <5 cm without rapid growth 3
• Typical ultrasound features: hyperechoic, well-circumscribed, minimal vascularity 3
• No red flags such as deep location, pain, or rapid enlargement 3

Complete en-bloc surgical excision provides excellent long-term local control for these straightforward cases 1.

Critical Red Flags Requiring Specialized Referral

You must refer to a sarcoma center or surgical oncologist (not general surgery) when encountering:

High-Risk Features Requiring Sarcoma MDT

• Deep-seated masses or any mass >5 cm diameter 4
• Retroperitoneal or intra-abdominal location - these require specialist sarcoma MDT evaluation before any surgical intervention 4
• Atypical imaging features on MRI: nodularity, thick septations, or concerning characteristics 4, 3
• Diagnostic uncertainty between lipoma and atypical lipomatous tumor (ALT)/well-differentiated liposarcoma 4

The Atypical Lipomatous Tumor Problem

This is a critical pitfall: ALT/well-differentiated liposarcomas can appear similar to large lipomas but require different surgical approach 4. MRI can differentiate these in only 69% of cases 4, 3. When suspicion exists, percutaneous core biopsy for MDM-2 amplification testing is mandatory before surgery, as this definitively distinguishes lipoma from ALT and fundamentally alters surgical planning 4.

Location-Specific Considerations

Cosmetically Sensitive Areas

Plastic surgeons are preferred for lipomas on the face, neck, or other areas where cosmetic outcome is paramount 1.

Specialized Anatomic Sites

• Retroorbital lipomas: require surgeons with specific orbital surgery training 1, 5
• Deep extremity or lower limb masses: higher suspicion for ALT, often warrant sarcoma specialist evaluation 4

Practical Algorithm

1. Initial assessment: Document size, depth, growth rate, pain 3
2. Ultrasound triage: First-line imaging for suspected superficial lipomas 3
3. If typical features + superficial + <5 cm: General surgeon referral acceptable 1, 3
4. If ANY concerning features: MRI and consider sarcoma center referral 4, 3
5. If deep OR >5 cm OR atypical imaging: Mandatory sarcoma MDT referral 4

Common Pitfall to Avoid

The most dangerous error is treating a large, deep lipomatous mass as a simple lipoma without proper imaging and specialist evaluation. ALTs have high local recurrence rates if inadequately excised, and progressive dedifferentiation can occur with each recurrence 4. The British Sarcoma Group specifically produced guidance to help identify which lipomatous masses need sarcoma unit referral versus local management 4.