What's Up Doc? My doctor says this lump on my neck doesn't need treatment
Q: I developed a lump under the skin of my neck that my doctor said was a kind of tumor, a lipoma. She said it was benign and we can just watch it and do nothing. Does that sound right?
A: Lipomas are encapsulated (meaning surrounded by a fibrous capsule) lumps of fatty tissue (mature fat cells). They are slow growing and benign (not cancerous).
Lipomas can occur essentially anywhere in the body, and in some situations can cause issues. Lipomas in:
the gastrointestinal tract can bleed, or if large enough cause a blockage or other complications.
the respiratory tract can also bleed, or if large enough cause a blockage or other complications.
the muscles can interfere with movement or cause pain or other symptoms.
other locations can cause symptoms that depend on the site involved and the specifics of their size.
Over half of all lipomas are subcutaneous lipomas (SL’s, located just under the skin) like yours, so that will be the focus of today’s column.
SL’s are the most common soft-tissue tumors. One of every 100 people will get at least one in their lifetimes. The reason they occur is not known, but there is a genetic component to developing a lipoma, so if you have a close relative who has had a lipoma you are even more likely to develop one. Although anyone can develop them, they most commonly occur in older adults (average ages between 40 and 60).
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SL’s are most commonly located on the trunk, extremities, back, neck and/or shoulders, but they can occur anywhere. They are typically painless (although if they happen to push on a nerve or other sensitive structure they can cause pain), soft (often described as feeling ‘doughy’), easily movable (when you push them with your finger they slide around slightly; they are not strongly anchored to underlying rigid structures), typically smaller than 2 inches in diameter, and round/oval (although they can sometimes be lobulated).
The diagnosis of a SL is made based on the history and physical exam (H&P), specifically verifying that the ‘lump’ has the characteristics identified above.
Since cysts (encapsulated lesions filled with fluid, tissue, etc.) are also soft, "mushy," movable lesions, sometimes an ultrasound is done to help characterize the lesion. If fluid is noted on ultrasound, a needle may be inserted to aspirate the fluid so it can be evaluated.
Abscesses (sometimes colloquially called "ingrown hairs") can also be mushy feeling, movable subcutaneous lesions, although these are typically panful, faster growing, and can sometimes have signs of infection in the skin over the lesion. Abscesses are often treated by making a small incision to drain them and, if large enough, gauze packing may be placed in them to help prevent quick closure of the incised capsule and subsequent re-accumulation of the pus. If needed, an ultrasound can verify fluid in a pus-filled abscess.
If the physical exam and (if needed) ultrasound still leave uncertainty, a biopsy may be done. Typically this is an excisional biopsy where the lesion is completely removed and then the tissue evaluated under a microscope.
Since SL’s are slow growing benign lesions, no treatment is usually required. However, if they are causing symptoms, or if the patient has concerns over their cosmetic appearance, then they can be surgically removed (the area numbed and the lesion excised), or in some cases, per patient preference, liposuction (where the fatty cells are sucked out) can be used to treat them.
When completely removed, SL’s typically do not recur. However, especially since there is a genetic component to developing SL’s, patients may develop other SL’s over time.
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There are many potentially concerning causes of subcutaneous lumps (including cancers, infections and other conditions). So, if you notice a new lump anywhere on your body it is a good idea to have it checked by your health care provider.
Jeff Hersh, Ph.D., M.D., can be reached at DrHersh@juno.com.
This article originally appeared on MetroWest Daily News: lump on the neck may be a lipoma and probably needs no treatment
