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IntroductionExtremity Sarcoma ServiceMyself and Bas Masri200 Sarcomas per yearMonday clinic every weekMultidisciplinary service
ProblemSignificant % of patients
Delay in diagnosisInappropriate surgeryCompromises Limb SalvageRequires more RT/Chemo/Amputations
BUT – huge overlap between benign and malignant
PresentationPresent as
Mass8mm up to 50cm or morePainless or painfulGrow slowly or quicklySoft or firm or hard
PresentationSuspicious if:
>5cmGrowingDeep to the fascia
Look for systemic conditionsNFFamily History Li Fraumeni
Presentation
WorkupClinical ExaminationUltrasound
Very non-specificGuide you to size and depthMonitor over time
Workup
Workup
WorkupMRI Guidelines
All lesions >5 cmAll deep lesionsAll rapidly growing lesions
(I do MRI for everything – my pre-test probability is >70%)
WorkupMRI ?before referral
If you can – do it!But don’t delay by > a week or two
Biopsy
Having the Correct Diagnosis Never Impedes Management
(Clarkson’s First Law)
Biopsy
BiopsyFNA
50% accuracy. So toss a coin instead
Core BiopsyRequires experienced pathologist98% accuracyMake sure leave a scar
Open BiopsyIf needs an open biopsy – refer it.
Straight to Excision
Straight to Excision
Some Cases
SummaryDeep/Large/Growing = BadExcise if <5cm/superficial/stableMRI for suspicious lesions
We are happy to review cases
