While there is no clear distinction in Turkey, there are actually two diseases that are similar but different in many ways, and their differences will be discussed as they come up.
The term “lipoma” is commonly used to refer to a type of benign tumor under the skin. There is a yellow layer under the skin that serves as a supportive tissue, reduces the impact of traumas with a buffering effect, provides insulation in cold and hot conditions, and prevents heat loss throughout the body except for the scalp.
In individuals with higher body weight, this layer is thicker, while in thinner individuals, it is very thin. It is extremely thin on the eyelid but thickest around the belly button. Some parts of this layer may behave like an independent unit, becoming deformed and encapsulated into a mass, growing independently of weight fluctuations.
A tumor with a size ranging from 1 cm to 30 cm, surrounded by a capsule beneath the skin and separated from surrounding tissues, is referred to as a “lipoma” or “fatty tumor.”
While the majority is located under the skin, lipomas can occasionally occur in tissues and organs.
How Does a Sebaceous Cyst Form?
Although the cyst is of sebaceous origin, it has a very different structure and forms in a distinct way. There are sebaceous glands throughout the body, including the scalp, that produce sebum.
This secretion is responsible for increasing skin elasticity, providing protection against external influences, and imparting a unique identity to the individual in certain body areas (such as the armpits, groin, genitalia, anus) with its distinctive odor, which continues throughout life, although it decreases in advanced age.
If the duct through which this secretion reaches the skin becomes blocked, the secretion accumulates inside, leading to the formation of a cyst that can grow from 3-5 mm to 30-40 cm in diameter.
What Is the Difference Between a Cyst and a Lump?
Although their treatments are similar, they are two different conditions, and the correct diagnosis should be pursued. An experienced surgeon can distinguish between them through manual examination. Inexperienced surgeons may opt for an ultrasound for a definitive diagnosis, but this is an unnecessary procedure often performed to generate revenue for the hospital.
A lump is mass-shaped, like the tail of a sheep, immovable, and can be cut.
A cyst is butter-like in its spreadable structure.
A cyst is painless, while a lump may cause pain.
A cyst can become inflamed, whereas a lump does not.
A cyst is perfectly spherical, whereas a lump is more irregular in shape.
What Causes a Sebaceous Cyst?
Although the way it forms is known, the initiating factor or the primary cause of the deformed development of subcutaneous tissue and its independent growth remains unknown.
The cause of the cyst is the inability of the secretion to exit, and the reason for this is the blockage of the exit opening by natural pollutants such as dust. Xanthelasma with fat deposits around the eyelid and milia with keratin folds have been addressed in a separate heading.
What Are the Symptoms of a Sebaceous Cyst?
Under the skin, there are generally various-sized lumps, often in the shape of an egg, or numerous lumps. The lumps can be moved with the fingers.
Pain is usually absent but may occur if the cyst is under pressure, for example, under a belt, in the sitting area, under the arms, or in the palms due to squeezing.
If it is a cyst and becomes inflamed, additional symptoms such as severe pain, redness, and increased local heat may occur.
Ultrasound reveals a smoothly bounded tumoral formation beneath the skin.
What Should Be Done If a Sebaceous Cyst Hurts?
Normally, a lump doesn’t hurt. However, pain can occur when sitting on it or when it is squeezed by a belt; if prevention of squeezing is ensured, the pain usually resolves on its own. Nevertheless, the most appropriate approach is to have it removed.
Similarly, in the case of a cyst, there is typically no pain. If pain is present, it suggests that the cyst has become infected, inflamed, and formed an abscess. Antibiotics usually do not resolve the issue, and draining the abscess is necessary.
While draining the abscess, the capsule cannot be removed; therefore, after draining, the cyst may grow again in months or years.
How to Treat a Sebaceous Cyst on the Head?
Since there is no fat layer under the scalp, a lump cannot form. However, a lump can form at the back of the head; those on the scalp outside of the nape are cysts.
Neither a lump nor a cyst can heal on its own or with herbal products or medication. The only treatment is removal.
In our clinics, we use microsurgery to remove cysts from the head. Whether the cyst is 1 cm or 5 cm, we make an incision less than 1 cm on the skin, drain the content of the cyst, make the capsule small and empty like a bag, and remove it through the 6-7 mm hole. When removed in this way, there is no noticeable scar once the healing is complete.
With our specially developed microsurgery method, we do not cut the hair, so our patients do not show any signs of treatment when leaving the clinic. Since we close the incision with a glue called epi-glue without stitches, our patients can take a shower on the same day and do not need to have stitches removed or undergo dressing changes.
We can apply microsurgery to most of our patients, but in some cases, it may not be possible due to additional issues.
How Is Lipoma Treatment Conducted?
The treatment is similar to cyst treatment but with some differences. Since it is not possible to remove it by emptying its contents, making a very small incision, like 6 mm, is impossible; the incision should be large enough for surgical instruments to be placed under the skin and maneuver (1).
Except for very large lipomas, we usually remove them by making the smallest possible incision in the skin, typically around 2–3 cm. If the mass is not very large, we do not stitch the wound but instead use epiglue to glue the skin.
Since we do not use stitches, the patient can take a shower on the same day, and there is no need for additional procedures such as dressing changes, wound care, or stitch removal. Thanks to epiglue, the risk of pain and inflammation is kept to a minimum.
What Should Be Done to Remove a Sebaceous Cyst?
It is a trivial condition, but as the cyst grows, the surgery will also be more extensive. Therefore, a decision should be made, and the opinion of an expert should be sought. The removal should be carried out based on the expert’s advice.
Before removal, factors such as the method of removal, the microsurgical procedure, the experience and expertise of the clinic, their accumulated knowledge, their pricing policy, and their approach to patients should be investigated. After conducting this research, the procedure should be performed by a clinic or doctor in whom trust is placed.
Can a Sebaceous Cyst Turn into Cancer?
Absolutely not. It starts as a cyst and, even if it reaches enormous sizes, it never turns into cancer. The same applies to cysts; they cannot turn into cancer, even if left untreated for many years. The fact that it does not turn into cancer should not be a reason to postpone your treatment because its growth can lead to additional problems.
What Is Liposarcoma?
Liposarcoma is a type of cancer that originates from the subcutaneous fat tissue. Although it may resemble lipoma in name and structure, it is a different disease. Liposarcoma is not a result of lipoma turning into cancer but is a form of cancer that begins in the fat tissue (2).
Liposarcoma has a brownish color, unlike the yellowish appearance of lipoma, and its tissue structure is more fragile, easily crushed like mud when squeezed.
Although liposarcoma is a type of cancer, it does not cause death. It can reach massive sizes but is not lethal because it does not spread to other regions.
It is a very rare type of cancer.
What Are the Symptoms of Cancerous Lipoma?
There is not much difference from the benign ones; generally, they are larger, their shape and boundaries are not very clear, and their growth rate is higher. Their boundaries may not be clearly visualized on ultrasound.
However, it is not possible to diagnose cancer based on these characteristics alone. The only way to confirm cancer is through the examination of the removed tissue by a pathology specialist in the pathology laboratory.
Which Doctor/Specialty to Consult for Lipoma Treatment?
It falls under the general surgical branch. These are among the first surgeries that residents specializing in general surgery learn; in other words, they are procedures during their apprenticeship period. Although many surgical specialists can perform these procedures, general surgery is the only branch that receives specific training in this field and is parallel to the most experienced.
Rarely located in organs, those in specific locations are treated by relevant specialists. For example, those behind the eyeball are removed by an ophthalmologist, those inside the skull by a neurosurgeon, and those inside the mouth by an ear, nose, and throat specialist.
Why Do Lipomas Occur on the Eyelid, and How Are They Treated?
The accumulation of fat on the eyelids is called xanthelasma. Xanthelasma occurs when a yellow-colored substance consisting of cholesterol/lipids accumulates in thin plaque-like layers just below the top layers of the skin around the eyelids. Individuals with detected xanthelasma should have their blood cholesterol levels measured, consult an internal medicine specialist if high, and, with prescribed medications and diet, reduce their blood cholesterol to normal levels to prevent the recurrence of xanthelasma.
Treatment can be done by surgery, which involves cutting, and non-surgical methods.
Non-Surgical Xanthelasma Treatment
It is performed with radiofrequency, where the thin upper layer of the skin is eliminated using a very fine radiofrequency tip, reaching the fatty deposit, and then melting it away with radio waves. To reduce the likelihood of recurrence, the skin is left open. The resulting wound closes on its own within 1-2 weeks. For faster healing, prevention of inflammation, minimal scarring, and avoiding the formation of brown spots, a thin layer of Kutalin Cream should be applied immediately after the procedure and for the following 2-4 weeks.
Xanthelasma Surgery
In xanthelasma surgery, the skin is cut from the healthy skin border, the xanthelasma is removed by cutting down to an appropriate depth, and the skin is stitched. Surgery leaves a scar, and if the stitches are placed conventionally, a stitch mark remains.
How Does Lower Eyelid Lipoma Form, and How Is It Treated?
The cause has not been clearly explained, but it is more common in individuals with high blood cholesterol levels. It can also occur in individuals with normal or low blood cholesterol levels. The reason why it accumulates in this area has still not been clearly explained. The eyelids have the thinnest and softest skin covering the body, and accumulation may occur due to the thinness of the skin in this region.
While lower eyelid milia and syringomas may be confused with this condition, they are different diseases.
Non-Surgical Lipoma Treatment
Despite some clinics promoting it in this way, there is no non-surgical treatment for this condition. In reality, non-surgical treatment is not possible, but liposuction, a vacuum-assisted fat removal treatment, is different from surgery. Since the skin is cut only 6 mm instead of 2-3 cm, it can be considered non-surgical.
The liposuction method may be preferred for visible areas like the face to minimize scarring. However, when using liposuction, it cannot be ensured that the capsule is removed, and if the capsule is not removed, the condition may recur. Therefore, it is not a highly preferred method.
Some clinics using the term “non-surgical” may confuse xanthelasma on the eyelid and milia, which are seen on the eyelid. Both are not lipomas; xanthelasma is an accumulation of fat, and milia have no relation to fat but are related to the keratin structure, a layer of the skin.
Laser Lipoma Removal
There is no such treatment method. Although some cunning clinics advertise as “laser lipoma removal” to attract patients to the clinic, it is entirely a trap set for the patient. It is done with the logic of “let the patient come, and we’ll somehow convince them” and when the patient arrives, they are persuaded to other methods by saying, “yours is not suitable for laser.
References:
1- Boyer, M., Monette, S., Nguyen, A., Zipp, T., Aughenbaugh, W. D., & Nimunkar, A. J. (2015). A review of techniques and procedures for lipoma treatment. Clinic Dermatol, 3(4), 105-112.
2- Dei Tos, A. P. (2000). Liposarcoma: new entities and evolving concepts. Annals of diagnostic pathology, 4(4), 252-266.
3- Wilhelmi, B. J., Blackwell, S. J., Mancoll, J. S., & Phillips, L. G. (1999). Another indication for liposuction: small facial lipomas. Plastic and reconstructive surgery, 103(7), 1864-1867.
4- Op. Dr. Adil Altınsoy – Kötü Huylu Yağ Bezesi Nasıl Anlaşılır? – Lipom Tedavisi
5- Op. Dr. Atilla KAYA – Ksantelazma Nedir – Ksantelazma Tedavisi
