Lipomas are asymptomatic in most cases, although larger lesions that impinge on nerves are sometimes painful. A lipoma presents as a palpable, ill-defined, sometimes lobulated, soft or doughy mass, a “miniature pillow beneath the skin” (Fig. 56-1). Lipomas are mobile and not fixed to the overlying skin. They are common and usually make their initial appearance in early middle age. The size varies. Most are small, 2 or 3 cm in diameter, although lesions of long duration can be many centimeters in diameter.