Diagnosis is usually clinical – USS is not routinely required to confirm the diagnosis, except in the case of masses greater than 5cm diameter.
Removal of lipomata on cosmetic grounds is not routinely commissioned as per the KCCG procedures of limited clinical priority document accessible here:
Individual funding requests can be made for cases of exceptional clinical need.
- All masses over 5cm diameter should be imaged to exclude sarcoma
- Re-scan masses that have been previously diagnosed as benign if they have increased rapidly in size, have become painful or have developed other suspicious features.
- If there is a low clinical suspicion of sarcoma, refer for ultrasound at RCHT via choose and book. The radiologist will arrange further imaging or management as required.
If there is a high clinical suspicion of sarcoma, please refer via the 2ww pathway for suspected sarcoma.
Following imaging, the radiologists will refer the patient to the Sarcoma MDT if required without further action from the GP.
Even with a normal ultrasound or MRI scan, the radiologist may recommend a non 2ww referral to the surgeons for large symptomatic lipomas as slow-growing tumours are sometimes only detected histologically.
The following are the pre 2015 criteria for a 2ww sarcoma referral, which are of use in assessing the risk of malignancy:
- Measured diameter exceeds 5cm
- Significant persistent pain that is not solely pressure related
- Rapid growth over a short period of time
- Deep fixity to muscle or facia
- Prior malignancy – other than Basal Cell Carcinoma.
Current 2ww criteria for soft tissue sarcoma:
- Unexplained lump increasing in size (will be directed for ultrasound)
- Ultrasound scan findings that are suggestive of soft tissue sarcoma or an unexplained lump that is increasing in size
Ultrasound findings are uncertain and clinical concern persists
Once it is established that a lesion is not malignant the case is discharged from the pathway. The lipoma will not be removed in the absence of funding approval. Clinicians referring on this basis should make the patient explicitly aware of this.