Lipoma and Suspected Sarcoma

 

Introduction

Diagnosis of lipoma is usually clinical.  Except those whereby sarcoma is suspected and fast track referral is recommended, ultrasound is not routinely required to confirm the diagnosis of benign lipoma.

In scope             Suspected lipoma and sarcoma

Not in scope      Benign skin lesions not suspicious of lipoma or sarcoma

  

Red Flag Features

Consider sarcoma in the context of red flag features:

Unexplained soft tissue lump increasing in size.^1,2

Ultrasound or other imaging findings are suggestive of soft tissue sarcoma

Clinical concern persists and ultrasound or other imaging findings are uncertain

*This list is non exhaustive 

 

Investigations required prior to referral

In the absence of red flags or high suspicion of sarcoma, ultrasound is not routinely required to confirm the diagnosis.

 

Advice and Guidance

Discussion with a specialist should be considered if there is uncertainty about the interpretation of symptoms and signs, and whether a referral is needed.¹

Email rch-tr.GPRadiologyEnquiries@nhs.net

 

Referral instructions

Suspected sarcoma

Refer fast track suspected sarcoma if:

• Unexplained lump which is increasing in size
• Ultrasound or other imaging findings are suggestive of soft tissue sarcoma
• Ultrasound or other imaging findings are uncertain and clinical concern persists

FBC and UE including eGFR are required (less than 6 weeks old)

 

Following imaging, the patient will either be referred to the Sarcoma MDT meeting or returned to the care of the GP with explicit management recommendations on the USS report.

If there is significant persistent pain that is not solely pressure related and/or rapid growth (doubling in size in 3 months is a guide), a repeat scan is indicated. If there are any queries following imaging, the Radiology email advice service can be used: rch-tr.GPRadiologyEnquiries@nhs.net

 

Removal of benign lipoma

There is currently no commissioned pathway for large, symptomatic lipomas that have been deemed benign on imaging and have been returned to the care of the GP.

In cases of exceptional /unique clinical need, the GP may wish to make an individual funding request.

 

References

1. National Institute of Clinical Excellence.  Bone and Soft Tissue Sarcoma – Recognition and Referral.  Clinical Knowledge Summaries, August 2020
2. Hayes AJ et al.  UK Guidelines For The Management Of Soft Tissue Sarcomas.  British Journal of Cancer 2024
3. NHS Cornwall and Isles Of Scilly.  Commissioning Policies And Evidence Based Interventions 2022-2023.

  

Page Review Information

 

Review date	26 November 2024
Next review date	26 November 2026
Clinical editor	Dr Rebecca Hopkins
Contributors	Dr Rebecca Hopkins GP RMS Dr Kim Farmer, Consultant Radiologist, Royal Cornwall Hospitals NHS Trust Dr Tom Bean, Consultant Radiologist, Royal Cornwall Hospitals NHS Trust