Examination of Lipoma
Inspection:
- Site: more specific eg. Below the neck, at medial side of right upper scapula
- Number
- Size *remember to measure fingers breath length and width*
- Shape
- Surface
- Margin
- Overlying skin- any redness, was it shiny, any dilated vessels, punctum (sebaceous cyst)
- Any surgical scar *indicate recurrence
Palpation: *ask patient prior to palpation
- Confirm inspection findings (measure using measuring tape)
- Temperature *from normal to abnormal
- Tenderness
- Consistency
If soft or cystic swelling, can proceed with
A. Fluctuation test- put 2 fingers as testing fingers (A) , another 2 fingers at the other side (B),
feel the bouncing upwards at B when A tapped *2 planes
Positive= liquid/gas present
B. Trans-illumination test
Fixity
1. Arised from skin
Slide from surrounding to centre — to pinch the skin
If can be pinched= not arised from skin
Lipoma- skin can be pinched
Sebaceous cyst- skin cannot be pinched
2. Underlying muscle
Relax first then contract the muscle, 2 planes
If arised from muscle, when contract, mass becomes less prominent and not mobile
Special test
1. Lipoma
a. Slipping sign
Trace border of lump first, then press the border, if it slipped away= positive
(encapsulated lipoma)
Negative- dermoid/ sebaceous cyst
b. Lobulation sign
Squeeze using 2 hands to see, if negative means fat tissue not thick enough
Positive-overlying skin/ edges show series of curves and dimples
Encapsulated lipoma- attachment of fibrous septa from capsule of lipoma to overlying skin
2. Sebaceous cyst
a. Indentation test- positive
1 finger press at middle for 10s, if there’s presence of indentation = positive
b. Moulding test- positive
2 fingers press/mould from side, if there’s changing of round to crescentic shape = positive
Others
1. Reducibility
Try to sweep from side back into its own cavity thru its defect , if becomes flat back after
sweeping= reducible= hernia
If swelling at back, can TRO thoracic hernia
2. Compressibility
Try to sweep from side back, then becomes flat, then it bulges back= compressible
Eg. Varicose veins
Lastly, complete with lymph nodes examination.
Relevant questions
1. Classification of lipoma
According to anatomical sites
a. Subcutaneous
b. Sub facial/ subaponeurotic
c. Intermuscular
d. Retroperitoneal
e. Intra-articular
f. Subserous
g. Submucous
2. Definition of
A. Lipoma- slow-growing benign tumour arising from adult fat cells
B. Sebaceous cyst- arised from infundibular portion of hair follicles or from hair follicle
epithelium situated in dermis (not from sebaceous gland), a retention cyst containing
keratinous debris lined by keratinising squamous epithelium
3. How punctum develop?
Punctum= central- keratin, bluish spot, clinical sign indicating a connection between the cyst
surface and the cyst lining, content= yellowish white cheesy (mixture of sebum + fat +
desquamated epithelial cell debris, unpleasant smell)
4. Diabetic patient + tender swelling = carbuncle
Furuncles (boils) are skin abscesses caused by staphylococcal infection, which involve a hair follicle
and surrounding tissue. Carbuncles are clusters of furuncles connected subcutaneously, causing
deeper suppuration and scarring.
5. Lipoma- surgery: Excisional biopsy (30mins) + HPE- can done under LA unless very big size or
require patient in a hard-to-maintain position during operation need GA
Indications:
- When the mass causing discomfort to patient
- Cosmetic reason
- Too near nerve root causing pain
Complications post-op: overlying skin numbness
Rare complications: liposarcoma, secondary infection
Other complications:
- Haemorrhage within tumour
- Ulceration
- Calcification
- Saponification
- Myxomatous degeneration
6. Type of local anaesthesia: 1% lignocaine
Max safe dose: 3mg/kg