Article: Minimal Incision Extraction of Lipomas
Authors: Michael T. Cosulich; Matthew A. Molenda; Eliot Mostow; Ashish C. Bhatia; Robert T. Brodell
JAMA Dermatology, December 2014
Lipomas are benign proliferations of mature fat that are occasionally tender. Common treatment approaches include elliptical excision, liposuction, and injection lipolysis. For most lipomas, we favor the minimal incision or “squeeze” technique, whereby lipomas are expressed through a small scalpel or punch incision. To our knowledge, the utilization rate of this simple, effective technique has not been previously studied.
Minimal incision extraction has been adopted by many dermatologists because it is an office procedure with minimal complications, a specimen is produced to confirm the lesion’s benign nature, and lipomas are slow growing and unlikely to recur quickly, even if not completely removed. Minimal incision extraction is favored compared with elliptical excision because it is quick, easily and safely performed in the office setting, and allows removal during a standard visit rather than rescheduling patients for a more time-consuming elliptical excision. Lipoma extraction through MIE is particularly easy and practical in patients with multiple painful lipomas. Our survey revealed a significant difference between the rate of dermatologist use of MIE for 1-cm and 3-cm lipomas (67.8% vs 55.2%; P = .04), suggesting that practitioners find removing larger lipomas more difficult with this technique. Certainly, larger lipomas may require dissection, piecemeal removal, or more hemostasis, and are more time consuming, but MIE is still possible and more efficient than elliptical excisions in most cases.2 We have used MIE on lipomas of up to 14 cm. Limitations of this study include a geographically limited study population and the lack of data to discern whether respondents would choose different techniques based on body location.
The survey data demonstrate that approximately 33% of dermatologists do not use MIE, even for solitary 1-cm lipomas, and that the most commonly cited reason for not treating lipomas was being uncomfortable with this procedure. Perhaps after seeing a demonstration (Video) of this quick and simple technique, more dermatologists will be willing to attempt MIE. Other physicians may be waiting for more outcome data demonstrating the recurrence rate after MIE vs elliptical excisions. One case series using MIE had a recurrence rate of 1.4%, but this source did not disclose the follow-up period or provide comparative data.3 Our clinical experience with this procedure suggests that the recurrence risk after MIE is low, and when recurrences occur, they can be treated with the same MIE technique, avoiding the need for an elliptical excision.
WARNING: This video contains surgical procedures.The Minimal Incision Extraction Demonstration video contains surgical procedures. To view this video click the link below: