{"id":4458,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/suspectedsofttissuetumour\/"},"modified":"2026-01-29T08:41:47","modified_gmt":"2026-01-29T08:41:47","slug":"suspectedsofttissuetumour","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/orthopaedics\/sarcoma\/suspectedsofttissuetumour\/","title":{"rendered":"Suspected Soft Tissue Tumour"},"content":{"rendered":"\n<p>The vast majority of soft tissue lumps are benign.<br>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.<br><br><br><strong>Assessment<\/strong><br><br>The following features are associated with an increased chance of malignancy:<br>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 1. Size greater than 5cm<br>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 2. Deep to the deep fascia<br>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 3. Rapidly enlarging<br>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 4. Significant pain (rare and the least sensitive feature)<br><br><strong>Additional guidance<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-table is-style-regular\"><table><tbody><tr><td><strong>\u200bSize<\/strong><\/td><td>Golf ball&nbsp;=&nbsp;4cm diameter<br><br>Tennis ball &#8211; 7cm in diameter\u200b<br><\/td><\/tr><tr><td>\u200b<strong>Depth<\/strong><\/td><td>\u200bA superficial lump will be mobile. It originates in the skin or subcutaneous fat.<br><br>A deep lump is not mobile. It may be less obvious with muscle contraction and will be more fixed in position.<br><\/td><\/tr><tr><td>\u200b<strong>Rapidly enlarging<\/strong><\/td><td>\u200bSignificant and progressive increase in size over a number of weeks.<br><br>A lump that is slowly enlarging over many months is not rapidly enlarging.<br><br>Lumps that vary in size are less worrying.<br><\/td><\/tr><tr><td><strong>\u200bSignificant pain<\/strong><\/td><td>\u200bPain more than a mild intermittent ache.<br><br>Pain directly related to the lump.<br><\/td><\/tr><tr><td><strong>Other Concerning Features<\/strong><\/td><td>Fungating<br><br>Hard or craggy<br><br>At site of previous tumour excision or within a previous radiotherapy field.<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p><strong>MM &amp; MA 14\/1\/26<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Who to refer<\/h4>\n\n\n\n<p>Patients with suspected soft tissue sarcoma (in line with <a href=\"https:\/\/www.gov.scot\/binaries\/content\/documents\/govscot\/publications\/advice-and-guidance\/2025\/08\/scottish-referral-guidelines-suspected-cancer-2025\/documents\/scottish-referral-guidelines-suspected-cancer-2025\/scottish-referral-guidelines-suspected-cancer-2025\/govscot%3Adocument\/scottish-referral-guidelines-suspected-cancer-2025.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Scottish Referral Guidelines for Suspected Cancer 2025<\/a>):<br><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>A soft tissue mass with one or more of the following characteristics:\n<ul class=\"wp-block-list\">\n<li>5 cm or more in size (unless long standing \u2013 see good practice regarding lipoma<\/li>\n\n\n\n<li>deep, tethered, fixed or immobile<\/li>\n\n\n\n<li>rapidly increasing in size (over weeks to months)<\/li>\n\n\n\n<li>hard or craggy<\/li>\n\n\n\n<li>fungating<\/li>\n\n\n\n<li>occurring in the site of a previous lump excision or within a previous radiotherapy field<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>USS suspicious for a soft tissue sarcoma<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Who not to refer:<\/h4>\n\n\n\n<p><strong>Head or neck lumps<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Refer ENT Neck Lump Pathway<\/li>\n<\/ul>\n\n\n\n<p>&nbsp;<br><strong>Superficial soft tissue lumps &lt; 5cm<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Refer General Surgery or locality minor surgery service, where available.<\/li>\n<\/ul>\n\n\n\n<p>&nbsp;<br><strong>Abdominal Lumps<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Refer General Surgery.<\/li>\n<\/ul>\n\n\n\n<p><\/p>\n\n\n\n<p><strong>Gastrointestinal Stromal Tumours (GIST)<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Refer WGH Colorectal Service<\/li>\n<\/ul>\n\n\n\n<p><strong>Children and Young People aged 15 years of younger<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>USC referral for children and young people age 15 and under should be via appropriate paediatric service.<\/li>\n<\/ul>\n\n\n\n<p><strong>Lipoma:<\/strong><\/p>\n\n\n\n<p>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:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>A Dome-shaped or egg-shaped lump usually 2-10 cm in diameter<\/li>\n\n\n\n<li>May grow slowly over several years<\/li>\n\n\n\n<li>Feels soft and smooth and is easily moved under the skin with the fingers<\/li>\n\n\n\n<li>May have a rubbery or doughy consistency<\/li>\n<\/ul>\n\n\n\n<p>A lipoma noted above<\/p>\n\n\n\n<p>Source (<a href=\"https:\/\/www.gov.scot\/binaries\/content\/documents\/govscot\/publications\/advice-and-guidance\/2025\/08\/scottish-referral-guidelines-suspected-cancer-2025\/documents\/scottish-referral-guidelines-suspected-cancer-2025\/scottish-referral-guidelines-suspected-cancer-2025\/govscot%3Adocument\/scottish-referral-guidelines-suspected-cancer-2025.pdf\" data-type=\"link\" data-id=\"https:\/\/www.gov.scot\/binaries\/content\/documents\/govscot\/publications\/advice-and-guidance\/2025\/08\/scottish-referral-guidelines-suspected-cancer-2025\/documents\/scottish-referral-guidelines-suspected-cancer-2025\/scottish-referral-guidelines-suspected-cancer-2025\/govscot%3Adocument\/scottish-referral-guidelines-suspected-cancer-2025.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Scottish Referral Guidelines for Suspected Cancer 2025<\/a>)<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">How to refer:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Complete the Musculoskeletal Tumour Service referral form via SCI Gateway\n<ul class=\"wp-block-list\">\n<li>Lauriston Buildings &gt;&gt; Orthopaedics &#8211; Sarcoma<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Refer as Urgent Suspected Cancer<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p>\u200bRIE Orthopaedic Sarcoma Nurse Specialist: Ashleigh Brown,&nbsp;<a href=\"mailto:ashleigh.brown@nhslothian.scot.nhs.uk\" target=\"_blank\" rel=\"noreferrer noopener\">ashleigh.brown@nhslothian.scot.nhs.uk<\/a><\/p>\n\n\n\n<p>CANCER REFERRAL GUIDELINES (<a href=\"http:\/\/www.cancerreferral.scot.nhs.uk\/\" target=\"_blank\" rel=\"noreferrer noopener\">www.cancerreferral.scot.nhs.uk<\/a>)<\/p>\n\n\n\n<p>SARCOMA UK (<a href=\"https:\/\/sarcoma.org.uk\/\" target=\"_blank\" rel=\"noreferrer noopener\">www.sarcoma.org.uk<\/a>)<\/p>\n\n\n\n<p><a href=\"http:\/\/www.edinburghorthopaedics.org\/\" target=\"_blank\" rel=\"noreferrer noopener\">http:\/\/www.edinburghorthopaedics.org\/<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/www.gatewayc.org.uk\/scotland-video\/sarcoma-and-bone-cancers\/\" data-type=\"link\" data-id=\"https:\/\/www.gatewayc.org.uk\/scotland-video\/sarcoma-and-bone-cancers\/\" target=\"_blank\" rel=\"noreferrer noopener\">Sarcoma and bone cancers &#8211; GatewayC video<\/a><\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>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<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":4404,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[421],"class_list":["post-4458","page","type-page","status-publish","hentry","category-suspected-soft-tissue-tumour"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/orthopaedics\/sarcoma\/suspected-soft-tissue-tumour\/\" rel=\"tag\">Suspected Soft Tissue Tumour<\/a>","rttpg_excerpt":"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","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4458","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=4458"}],"version-history":[{"count":8,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4458\/revisions"}],"predecessor-version":[{"id":26442,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4458\/revisions\/26442"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4404"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=4458"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=4458"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}