The vast majority of soft tissue lumps are benign.
Approximately 3000 new soft tissue sarcomas are diagnosed each year in the UK. A full time GP is likely to diagnose only one during their career. These can occur at any age, but most often in middle aged and older adults. Around 80% of new cases are diagnosed in people aged 40 years or older.
Assessment
The following features are associated with an increased chance of malignancy:
1. Size greater than 5cm
2. Deep to the deep fascia
3. Rapidly enlarging
4. Significant pain (rare and the least sensitive feature)
Additional guidance
| Size | Golf ball = 4cm diameter Tennis ball – 7cm in diameter |
| Depth | A superficial lump will be mobile. It originates in the skin or subcutaneous fat. A deep lump is not mobile. It may be less obvious with muscle contraction and will be more fixed in position. |
| Rapidly enlarging | Significant and progressive increase in size over a number of weeks. A lump that is slowly enlarging over many months is not rapidly enlarging. Lumps that vary in size are less worrying. |
| Significant pain | Pain more than a mild intermittent ache. Pain directly related to the lump. |
| Other Concerning Features | Fungating Hard or craggy At site of previous tumour excision or within a previous radiotherapy field. |
MM & MA 14/1/26
Who to refer
Patients with suspected soft tissue sarcoma (in line with Scottish Referral Guidelines for Suspected Cancer 2025):
- A soft tissue mass with one or more of the following characteristics:
- 5 cm or more in size (unless long standing – see good practice regarding lipoma
- deep, tethered, fixed or immobile
- rapidly increasing in size (over weeks to months)
- hard or craggy
- fungating
- occurring in the site of a previous lump excision or within a previous radiotherapy field
- USS suspicious for a soft tissue sarcoma
Who not to refer:
Head or neck lumps
- Refer ENT Neck Lump Pathway
Superficial soft tissue lumps < 5cm
- Refer General Surgery or locality minor surgery service, where available.
Abdominal Lumps
- Refer General Surgery.
Gastrointestinal Stromal Tumours (GIST)
- Refer WGH Colorectal Service
Children and Young People aged 15 years of younger
- USC referral for children and young people age 15 and under should be via appropriate paediatric service.
Lipoma:
A lipoma is a benign lump, which can affect up to 1% of the population and is most frequent in people aged 40 to 60 years. It has the following features:
- A Dome-shaped or egg-shaped lump usually 2-10 cm in diameter
- May grow slowly over several years
- Feels soft and smooth and is easily moved under the skin with the fingers
- May have a rubbery or doughy consistency
A lipoma noted above
Source (Scottish Referral Guidelines for Suspected Cancer 2025)
How to refer:
- Complete the Musculoskeletal Tumour Service referral form via SCI Gateway
- Lauriston Buildings >> Orthopaedics – Sarcoma
- Refer as Urgent Suspected Cancer
RIE Orthopaedic Sarcoma Nurse Specialist: Ashleigh Brown, ashleigh.brown@nhslothian.scot.nhs.uk
CANCER REFERRAL GUIDELINES (www.cancerreferral.scot.nhs.uk)
SARCOMA UK (www.sarcoma.org.uk)
