Lipoma Examination is a basic short case OSCE skill the undergraduates must-have. Firstly, introduce yourself and get consent before you touch the patient.
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 5 cm in diameter, over the right scapula. It is not tender, the surface is lobulated and the edge is well defined. The lump is freely mobile. It is not attached to the skin or the underlying muscle. It is soft in consistency, fluctuant and transilluminant.
So, my probable diagnosis is a lipoma and I would like to offer him surgical excision under LA if it is cosmetically unacceptable.
It is a benign tumour that consists of mature fat cells.
It is characterized by multiple painful lipomas.
No. But liposarcoma can occur de novo.
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. Alternatively, suction lipolysis can be used.