Risks would include infection and bleeding. Some plastic surgeons will do this with liposuction, but I have found that personally the recurrence rate is quite high when I have tried to do it with liposuction, so I generally just excise them. There is really no alternative to treatment other than surgery. With his permission, I have drawn how we would incise the skin over these and about how long the scar would be. MEDICAL DECISION MAKING: The patient has multiple lipomas (Diagnosis) which are tender.
He has four on his right upper extremity, two on his lower forearm and two on his posterior arm. PHYSICAL EXAMINATION: On examination, he has subcutaneous masses of his left forearm and two spots of his left posterior arm. (Social history)įAMILY HISTORY: He does have a family history of melanoma in his paternal grandfather who died from it. PAST SURGICAL HISTORY: Nasal surgery, knee surgery. (HPI: Quality) They get irritated when he is handling people as a firefighter. (HPI: Severity) Some of them are tender to touch. Mark is a 45 years-old male and is here as a new patient (New patient) to have several lipomas removed.(Chief complaint) He has had these for many years.(HPI: Duration) He has had about 12 removed.(ROS: Integumentary) They get bigger slowly over time. Position and mobility are normal.ĪDNEXA/PARAMETRIA: No masses or tenderness noted.īased on the 1995 documentation guidelines, what is the level of exam? UTERUS: Uterus non-tender and of normal size, shape and consistency. No discharge.ĬERVIX: The cervix is clear, firm and closed. VAGINA: Mucosa clear without lesions, Pelvic support normal. URETHRA: No masses, tenderness or scarring.īLADDER: Without fullness, masses or tenderness. URETHRAL MEATUS: Meatus appears normal in size and location. No atrophy, adhesions, erythema, or vesicles noted. SKENE'S: No cysts, abscesses, induration, discharge, masses, or inflammation noted.ĬLITORIS/LABIA MINORA: Clitoris normal.
VULVA/LABIA MAJORA: No erythema, ulcerations, swelling, or lesions seen.īARTHOLIN GLANDS: No cysts, abscesses, induration, discharge, masses, or inflammation noted. GENERAL APPEARANCE: Healthy appearing individual in no distressĪBDOMEN: Soft, non-tender, without masses.
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