General Indications for Operation of Soft Tissue Masses

There are a lot of patients presenting with soft tissues masses in the extremities and trunk and neck.  Most of these are benign, usually lipomas, neurofibromas, etc.   The general approach is to wait and watch or monitoring without resorting to operation right away.

Below are the general indications for operation of soft tissue masses located in the extremities, trunk and neck, excluding epidermal cysts and skin tumors.

  1. When there is significant degree of suspicion for a malignant (cancerous) soft tissue tumor.  Only the physician can quantitate this degree of suspicion based on his examination.  For example, if the physician is quite sure the soft tissue mass is a lipoma or neurofibroma, then the degree of suspicion for a malignant tumor is quite low (say 1%).  If characteristics of the soft tissue mass do not present with the pattern of a lipoma or neurofibroma or any other benign (non-cancerous) lesion and if the pattern is that of a malignant tumor, then there is a high degree of suspicion for a malignant soft tissue tumor.  In which case, there is an indication for an operation, which can be an incision or excision biopsy or wide-excision biopsy.  If characteristics of the soft tissue mass do not present with the pattern of a lipoma or neurofibroma or any other benign (non-cancerous) lesion and if there is a significant degree of suspicion for a malignant soft tissue tumor, again, there is an indication for an operation, which can be an incision or excision biopsy or wide-excision biopsy.
  2. If a benign (non-cancerous) soft tissue tumor such as lipoma or neurofibroma is highly suspected, the size of the mass is then considered when deciding for operation or not. When the size of the mass is significantly big, say about 3 cm or greater, which is usually obvious seen by the naked eye, an operation is usually indicated.   The rate of growth of the mass is also considered together with the size.  If it is less than 3 cm and the size has been stationary or there is no significant increase in size since it was noted, the benign soft tissue tumor may be monitored and no immediate operation is usually needed.  If the suspected benign soft tissue tumor is fast growing, say 1 cm  or bigger in one year, even if the current size is less than 3 cm, then operation is usually needed.
  3. If a benign (non-cancerous) soft tissue tumor such as lipoma or neurofibroma is highly suspected, if it is not fast growing, even if the size is less than 3 cm, the other (may be the last) factor to consider is whether it bothers the patient, physically, socially, and /or mentally.  Physically, when the mass is located in an area that hinders free movement or normal body function.  Socially, when the mass is located in an area that presents as a cosmetic concern (obviously or evidently seen by a third party).  Mentally, despite the assurance of the physician that it is most likely benign, patient still worries about the diagnosis, about the probability.  If the patient is bothered by soft tissue mass physically, socially, and/or mentally, an operation is usually needed.

 

ROJ-TPOR@16feb29

 

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