Lipoma

1. Site - Commonly over the front and back of the chest.

2. Size Medium to large.
3. Shape - Hemispherical.
4. Skin - Scar? (Recurrence?)
5. Surface - Lobulated. 

6. Edge - Well defined.
7. Tissue plane - Freely mobile (Slipping sign). Not attached to skin or underlying muscle. Try to elicit      the tissue plane of the lipoma by contracting the underlying muscle. When the muscle is contracted,

• If the lump becomes prominent - a subcutaneous lipoma.
• If the lump becomes less prominent - an intramural lipoma.

8. Consistency - Soft to firm depending on the nature of fat within it.
9. Fluctuance - Fluctuant (Pseudofluctuant). 

10. Transillumination - May be transilluminant.

There is a hemispherical shaped lump, measuring 5cm in diameter, over the right scapula. It is not tender; the surface is lobulated and the edge is well defined. It is freely mobile and not attached to skin or the underlying muscle. It is soft in consistency, fluctuant and transilluminant.

So my probable diagnosis is a lipoma and would like to offer him surgical excision under LA if it is cosmetically unacceptable.

1. Commonly over the front & the back of the chest. 

2. Medium to large.
3. Hemispherical.
4. Scar?
5. Lobulated.
6. Well defined.
7. Not attached to skin or underlying muscle.
8. Soft to firm.
9. Pseudofluctuant.
10. May be transilluminant.

Library

1. What is a lipoma?

It is a benign tumour that consists of mature fat cells.

2. What is Dercum's disease?

It is characterized by multiple painful lipomas.

3. Can they undergo malignant transformation?

No. But liposarcoma can occur de novo.

4. What is the treatment for lipoma?

Usually by reassurance. But surgery is offered if the patient complains of pain or if it is cosmetically unacceptable. It is removed by either simple surgical excision under LA or suction lipolysis after obtaining the consent.