Lipomas are benign tumors of adipose tissue that rarely occur in the neck, cause cosmetic deformations and their treatment is exclusively surgical.
Lipoma is a mesenchymal tumor; that is a tumor that develops from adipose tissue.
These cervical tumors vary in size, the majority being contained within 3-4 cm in diameter. In some cases they reach 10 centimeters in their major axis. When they exceed 10 centimeters, it is called a giant lipoma.
Diagnosis is simple. In many cases medical examination is sufficient. Upon inspection an oval or rounded mass is appreciated. On palpation it is perceived that the surface is smooth and there are no adhesions with the deep planes. The texture is soft and fluffy. There are very rarely signs of compression on the vessels and even less on the laryngeal-tracheal axis.
As far as benignity is concerned, lipomas can be considered almost all benign. Their malignant variant is called liposarcoma and is an exceptional response in the neck.
A rare variant is multiple symmetric lipomatosis (MSL).
As I said, there are two therapeutic choices for lipoma: either it is surgically removed or it is left in its place. There is no drug therapy. The removal can take place under local anesthesia only for small lipomas. In the majority the surgery is performed under general anesthesia.
The most important problem with benign head and neck diseases is when should it be removed?
There are otolaryngologists who have a tendency to wait. Four tests are normally used in masses in the head / neck area: ultrasound, ultrasound-guided needle biopsy, CT scan (Fig. 1) and MRI. It is difficult for you to have doubts about the benign condition with these tests, so telling a patient that you have to wait to remove a small tumor easily finds her consent. I am not of this opinion. The head and neck are complicated districts due to the numerous vascular and nerve structures that cross them and their respect is important in functional surgery. Waiting for a benign tumor to grow from small to large is a mistake. This position is logical if the patient is an elderly person, or if he suffers from chronic diseases. In these cases the operative risk is high.
Fig. 1 CT scan of the neck
In healthy patients, who can easily tolerate general anesthesia, my advice is to operate early. It will never be an emergency intervention, but it is an intervention that must be performed within a reasonable time.
If the diagnosis was early, i.e. lipoma less than 3 cm, it is possible to intervene under local anesthesia. Local surgery has numerous advantages, especially it is performed in a day hospital.
Waiting for a lipoma to grow I find it irrational. The risk of injuring important parts such as nerves or vessels or glands with the removal maneuvers increases as the days go by.
Lipoma is almost always painless, at most it leads to feelings of discomfort. However, it is good that the person who is affected undergoes an otolaryngological examination and instrumental tests that the specialist deems most appropriate. As often happens in medicine, many people do not know which specialist is the most suitable and sometimes they turn to general surgeons or dermatologists or plastic surgeons. It must be said that lipoma is not a skin tumor. In particular, neck lipomas involve a highly specialized area that requires specific experience and knowledge. Neck surgeons are otolaryngologists, so a lipoma should not be operated on by plastic or general surgeons or dermatologists.
Photo 2 - The neck
In the photo 2 we see a male patient who presented with a giant lipoma on the right side of the neck. I hope that family doctors will come to explain to their patients that one should never come to a situation like this.
In the photo 3 the lipoma after being removed. Its largest diameter is 15 centimeters. In practice it occupied the entire right side of the neck. The tumor mass was adherent to the jugular vein and other large vessels in the neck.
Photo 2. - Giant lipoma of the neck after excision.