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.
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. |
Who to refer:
Patients with suspected soft tissue sarcoma
- No additional imaging required prior to referral
- Initial referral for children and young people age 15 and under should be urgent and via appropriate paediatric service.
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.
Gastrointestinal Stromal Tumours (GIST)
- Refer WGH Colorectal Service
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)
