Lipomas

Q:  For about ten years I knew I had a marble-sized lump in my right thigh, but it never hurt or grew. About a year ago I noticed that it had grown considerably but it still didn't hurt. I mentioned it to my GP three or four months ago, and she just said that lumps are usually not malignant and nothing to worry about.

This spring my leg started to feel uncomfortable if I rolled over on that side in bed and sometimes the lump area itched or burned. Then I found several other small lumps in that same leg and my leg joints sometimes ached at night. I finally went to my GP for an exam, and she said it was probably lipomas, gave me some pages from a medical book, and referred me to a dermatologist. In the meantime I was finding new lumps every day or so, which were somewhat painful and felt like bruises.

Last week the dermatologist confirmed the diagnosis of lipomas and pretty much said that it's inherited, and there's nothing I can do except be selective about when I have them removed.

At this point I've lost track of how many lumps I have, but I'm sure it's close to 40. Many are in my upper legs, but they are also in my lower legs, upper and lower arms, trunk, and buttocks. Most of them are fairly small, but somewhat painful. I have managed without pain medication so far, but it is the unknowingness of how big, numerous, and painful they will become that is frustrating. I'm only in my early forties--will they keep popping up for a long time?

Of course a sense of control helps one psychologically manage an illness, and I haven't found any helpful suggestions for lifestyle changes. Although I am mildly overweight after having two children, I am far from obese. I'm adjusting to the feeling of being "invaded" by my own body, and I'm grieving the loss of my younger, lump-free body. If you know of any new research about management, I'll be grateful.

A:  Lipomas are benign growths composed of fat that usually occur under the skin, but have also been found in deeper tissues and even in various body organs, such as the heart, brain, and lung. They can vary from walnut size to that of a large baseball and usually have a soft, rubbery feel. Most arise after the age of 30.

Recent research has focused on classification of lipomas, because there are some variations. For instance some lipomas contain muscle cells as well as fat. You probably have the angiolipoma variant. This type contains clusters of blood capillaries within the fat. Angiolipomas tend to be multiple and can be painful.

Prior to considering removal, a biopsy should be done to confirm the type of lipoma. Removal is an option for very large, painful, or cosmetically unattractive, visible lipomas. This can be done by surgical excision, or liposuction can sometimes be performed and may result in less scarring. With so many lipomas, you and your doctor will have to be somewhat selective, keeping in mind that new ones may continue to crop up from time to time. Prior to consulting with a plastic surgeon, you probably should check with your insurance company regarding coverage. The good news is that your diet probably has no effect on lipomas and that is also the bad news. I'm not aware that any lifestyle changes, like diet or exercise, can reduce their size or occurrence.

"Dear Doctor" is a compilation of patient questions answered by doctors from the Medical College of Wisconsin.