We report hereby the case of a 61-year-old man who presented with a soft-tissue swelling on the palmar aspect of the thumb. A detailed clinical examination followed by ultrasonography and excisional biopsy confirmed a spindle cell lipoma. Lipomas are rare in the hand and exceptional in the fingers, and we report, to our knowledge, the first spindle cell lipoma in the thumb to help in the differential diagnosis of a similar swelling.

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Compliance with the ACCP guidelines is poor in this series; however, much of the discrepancy is based on grade 2C evidence. Only grade 1 evidence will reconcile the differences between the two guidelines.