Inadvertent excision of malignant soft tissue tumours

Abstract

Inadvertent excision of lumps which turn out to be sarcomas is not uncommon.Imaging has a limited role in detecting microscopic residual disease but can show the extent of the previous surgical field.Standard treatment is wide re-excision, usually combined with radiotherapy.Residual tumour is found in an average of 50% of reported cases.The presence of residual disease is an adverse prognostic factor.All lumps bigger than a golf ball should have a diagnosis prior to excision. Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180060.

Keywords: inadvertent excision; local recurrence; soft tissue sarcoma; unplanned excision; wide re-excision.

Fig. 1

The proportion of patients referred to our unit with an inadvertent excision based on the size of the original tumour (subcutaneous tumours only).

Fig. 2

Graph showing how the percentage of inadvertent excisions as a proportion of all new referrals has decreased over a 20-year period.

Fig. 3

(a) Coronal fat suppressed image shows a 1 cm lesion in the medial mid foot. Inadvertent excision of this lesion was performed with a subsequent histological diagnosis of synovial sarcoma. (b) Coronal fat suppressed image at restaging shows some oedema in the superficial fat at the site of the previous synovial sarcoma and no definite macroscopic residual disease. Wide re-excision showed no residual tumour.