This .mp4 video briefly demonstrates the minimal incision extraction technique for lipomas.
Cosulich MT, Molenda MA, Mostow E, Bhatia AC, Brodell RT. Minimal Incision Extraction of Lipomas. JAMA Dermatol. 2014;150(12):1360-1361. doi:10.1001/jamadermatol.2014.3234
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.1,2 To our knowledge, the utilization rate of this simple, effective technique has not been previously studied.
A survey was distributed to all 233 members of the Ohio Dermatological Association to determine if they treat lipomas. The preferred technique in several clinical scenarios was queried (1-cm lipoma, 3-cm lipoma, and multiple painful 1-cm lipomas). Treatment choices included elliptical excision, linear incision extraction (incision length, 100% diameter of lipoma), minimal incision extraction (MIE; incision length, 25%-50% of lipoma), referral, or “other technique.” Years in practice and practice focus were recorded (medical, surgical, or cosmetic). Statistical analysis used the Fisher exact and McNemar tests. This study was approved by the institutional review board of Northeastern Ohio Medical University.
There were 87 total respondents (37% response rate). The survey results are summarized in the Table. The lone response for other technique was liposuction. Dermatologists who choose not to treat lipomas most commonly responded that they were “uncomfortable with this procedure.” Practice type and years of experience did not affect the results significantly.
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.
Accepted for Publication: August 22, 2014.
Corresponding Author: Robert T. Brodell, MD, Department of Dermatology, University of Mississippi Medical Center, 2500 N State St, Jackson, MS 39216 (firstname.lastname@example.org).
Published Online: October 22, 2014. doi:10.1001/jamadermatol.2014.3234.
Author Contributions: Drs Cosulich and Brodell had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Cosulich.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Cosulich, Molenda.
Critical revision of the manuscript for important intellectual content: Mostow, Bhatia, Brodell.
Statistical analysis: Cosulich.
Administrative, technical, or material support: Molenda, Mostow, Bhatia, Brodell.
Study supervision: Bhatia.
Conflict of Interest Disclosures: Dr Brodell reports having received honoraria from presentations for Allergan, Galderma, 3M/Graceway Pharmaceuticals, GlaxoSmithKline/Stiefel, Dermik/BenzaClin Speaker Bureau, Novartis Pharmaceuticals Corporation, sanofi-aventis, Medicis Speaker’s Bureau, PharmaDerm (a division of Nycomed US Inc), and Veregen Speakers Bureau; receiving consultant fees from Galderma Laboratories, LP, Medicis, Dow Pharmaceuticals Sciences, and Promius Pharma; serving on the advisory boards of Dow Pharmaceuticals Sciences and Nycomed US Inc; and performing clinical trials for Genentech, Galderma, Abbott Laboratories, and Dow Pharmaceuticals Science. Dr Molenda reports having partial ownership rights in projects being developed by Cleveland Clinic Innovations and receiving consulting funds from Memorial Sloan Kettering Cancer Hospital. Dr Mostow reports receiving grants for clinical trials research from HealthPoint and speakers fees from HealthPoint and Ranbaxy Laboratories. No other disclosures were reported.