- Initial Work Up:
- primary goal is to determine whether the mass is benign or malignant;
- prior to biopsy the physician should determine:
- whether the mass is above or below the fascia (deep lesions are more often malignant);
- the exceptions are MFH and leiomyosarcoma which can occur in the subcuanteous tissues;
- anecdotally malignant superficial lesions will not appear as a discrete circular mass, but there are always exceptions;
- size of mass:
- if mass is > five cm, esp if it is deep and in thigh, it is likely to be a sarcoma;
- whether there are visible changes on x-ray (such as soft tissue calcification which can be seen in synovial sarcoma);
- it has been recommended by D.S. Springfield M.D. (JBJS 1996) that superfical masses feel like fat (lipoma), which do not cause pain
and which have not changed in size can be followed clinically;
- masses which are painful, have changed in size, or show suspicious x-ray findings, will require MRI and biopsy (either incisional biopsy or by needle);
