Treatment of Familial Multiple Lipomatosis: A Systematic Review

BACKGROUND: Familial multiple lipomatosis (FML) is a rare hereditary condition characterised by multiple subcutaneous lipomas, most commonly affecting the trunk and extremities. Although benign, the cumulative tumour burden can cause cosmetic disfigurement, discomfort, and functional limitation. Treatment options include conventional excision, liposuction, and injection lipolysis, but no consensus guidelines exist, and evidence remains fragmented. OBJECTIVES: To summarise reported management strategies, outcomes and recurrence rates to better inform clinical decision-making for the management of FML. METHODS: A systematic review was conducted in accordance with PRISMA guidelines using OVID Medline (1946-April 2025) and Embase (1974-April 2025). Of 4259 studies identified, 15 case reports met the inclusion criteria. Data were extracted on demographics, lesion distribution, management, and recurrence. RESULTS: Patients ranged from 14 to 71 years, with a male predominance and strong familial clustering. Lesions were typically soft, mobile, and non-tender, most often located on the arms, thighs, and the trunk. Excision was the primary treatment in most reports (n = 12), followed by liposuction (n = 2) and injection lipolysis (n = 1). Recurrence occurred with both excision and injection therapy, although follow-up data were inconsistently reported. CONCLUSIONS: Minimally invasive excision and liposuction-based approaches show promise for improved cosmesis. However, their interpretation in the current literature remains limited by low level evidence case reports, large heterogeneity between studies and the lack of standardised outcomes. This review consolidates the existing literature on FML, underscoring the need for further studies with patient-reported outcome measures to clarify recurrence risk and optimise management strategies.