Diagnostic Approach for Multiple Subcutaneous Masses

Clinical Evaluation and Imaging

The American College of Radiology recommends plain radiographs as the initial imaging study for suspected soft tissue masses, which can identify intrinsic fat, calcification, or bone involvement 1, 2
Ultrasound is the most useful initial imaging modality for superficial/subcutaneous masses, with sensitivity 94.1% and specificity 99.7%, and can characterize lipoma features such as hyperechoic or isoechoic appearance, well-circumscribed margins, and minimal to no internal vascularity 2, 3, 6
The British Journal of Cancer suggests that MRI without and with contrast is indicated for masses with concerning features, such as size >5 cm, deep location, or atypical ultrasound features 4, 5

The American College of Radiology states that any mass with atypical ultrasound features, such as heterogeneous echotexture, increased vascularity, or irregular margins, requires further evaluation with MRI or biopsy 2, 5
The British Journal of Cancer recommends that masses with red flags, such as size >5 cm, deep location, rapid growth, or pain, require MRI and/or core needle biopsy 4, 5, 6

The American College of Radiology suggests that small, superficial, asymptomatic lipomas with typical imaging features can be observed, with clinical follow-up at 6-12 months to assess for growth 6
The British Journal of Cancer recommends complete surgical excision as the standard treatment for symptomatic, rapidly growing, large, or atypical masses, with planning for removal of the biopsy tract during definitive surgery if malignancy is suspected 4, 6