Soft Tissue Masses of the Extremities

Introduction

Optimal management of extremity soft tissue masses requires an understanding of soft tissue sarcoma biology. The goal of the clinical evaluation is to discern local signs and symptoms concerning for malignancy as well as any relevant predisposing factors. Further evaluation proceeds based on the degree of suspicion of malignancy. Small masses without concerning clinical features are likely benign and can be observed. Masses that are larger than 5 cm, symptomatic, or growing warrant further investigation with a biopsy and imaging to establish key tumor factors (i.e., histologic subtype, grade, size, proximity to critical structures) that predict outcome and determine management. Radical resection versus multimodal or nonoperative treatment is dictated by anatomic and biological resectability. The details of a systematic approach are described herein.

Clinical Assessment

The history and physical examination are used to gauge the risk for malignancy. Pertinent history includes local symptoms (e.g., pain, distal neuropathy, growth) and predisposing factors for sarcoma (e.g., radiation, lymphedema, family history suggestive of genetic syndromes such as Li–Fraumeni, neurofibromatosis type I, FAP/desmoid). Nonneoplastic associations such as trauma should be noted. On physical examination, mass size, depth, mobility, consistency, tenderness, and distal neurovascular status should be assessed.

Generally, asymptomatic masses smaller than 5 cm are likely to be benign and can be observed. However, size greater than 5 cm, symptoms, or growth should raise the concern for neoplasm and prompt further evaluation.