A review of forehead lipomas: Important tips for the training surgeon

Background: Forehead swellings can be caused by a variety of different pathologies, including lipomas. These benign lesions are composed of mature fat cells and often result in a poor cosmetic appearance causing significant psychosocial distress. Surgical removal is therefore frequently requested and they are often listed on a training local anaesthetic list. Thus, it is essential that trainees understand the nature of these lesions, their anatomical location and management, as well as differential diagnoses.

Methods: A review of the available literature on forehead lipomas and their management was performed. Searches of both MEDLINE and EMBASE were conducted, with all full text articles published in English being included for analysis.

Results: 14 papers were included for analysis. Forehead lipomas are slow growing lesions with 100% presenting as a solitary swelling. They are more prevalent in males with mean age at presentation being 48 years. Their aetiology is unknown, however, blunt trauma has been postulated to contribute to their formation. Differential diagnoses include cysts and extension of intracranial lesions. Surgical intervention is the only recognised treatment, with a transverse, forehead-crease incision most commonly being adopted under local anaesthetic. Exploration beneath the frontalis muscle is often required in order to achieve their excision.

Conclusion: Important differential diagnoses must be excluded prior to attempted surgical excision of forehead lipomas. Surgeons must also be aware that the correct anatomical plane for these lesions is often beneath the frontalis muscle.