Lumps, bumps, and…nerve-end stumps? A collection of guidelines for safe in-office lipoma excision

Lipomas are benign adipose tumors frequently encountered by the primary care physician. They are the most common soft tissue tumor diagnosed in the adult population and generally present as soft, round, and discrete masses located in the subcutaneous tissues of nearly any anatomical location. In-office excision has become common practice, however, limitations of such settings along with varying locations and presentations of these lipomas may render the patient more susceptible to complications. This manuscript aims to provide the general practice provider with a set of safety guidelines for in-office lipoma excision, thus decreasing the chance of major complications. These guidelines include: obtaining a clear diagnosis prior to excision, ensuring familiarity with the anatomical location prior to excision, deferring excision if the lipoma appears to be located in the subfascial plane, and aborting excision if the patient is at risk for local anesthetic toxicity, if symptoms of motor blockade develop, or if uncontrolled bleeding occurs. The importance of these guidelines is highlighted by a case report of radial nerve injury sustained during an in-office lipoma excision requiring operative reconstruction of the radial nerve.