Bump on Back of Head: Could It Be a Lipoma?

A soft, movable, painless lump at the occiput (base of skull/neck junction) is highly suggestive of a lipoma—a benign neoplasm of mature adipocytes.

Lipoma Characteristics

• Texture: Soft, doughy, rubbery.
• Mobility: Easily movable under skin (not fixed to fascia/bone).
• Pain: Usually asymptomatic. Can hurt if large, compresses nerve, or is angiolipoma (vascular).
• Size: Typically 1–5 cm; can grow larger (giant lipoma >10 cm).
• Location: Subcutaneous. Common: neck, shoulders, back, arms, thighs.

Differential Diagnosis

• Epidermoid Cyst: Firm, central punctum, keratin expressible, fixed to skin.
• Lymph Node: Firm, mobile, tender if reactive/infected. Occipital nodes drain scalp.
• Dermatofibroma: Firm, dimple sign, usually legs.
• Pilomatrixoma: Hard, calcified, from hair matrix.
• Liposarcoma (Rare): Deep, large (>5 cm), rapid growth, fixed. MRI + biopsy.

Management

• Observation: Asymptomatic, small, classic features → no treatment needed.
• Excision: Indicated for pain, nerve compression, cosmetic concern, diagnostic uncertainty, rapid growth. Local anesthesia, office procedure. Recurrence <5% if capsule fully removed.
• Liposuction: For large lipomas; less scarring but higher recurrence (capsule left).

See a doctor for confirmation. Ultrasound or MRI if deep/large/atypical. Do not attempt self-removal.