IV. Precautions: Red flags for Malignancy

  1. Firm, deep masses adherent to adjacent structures
  2. Large lesions >5 cm in diameter (golf ball size)
    1. Accounts for 90% of malignant lesions
    2. However, diameter <5 cm does not exclude malignancy
  3. Consistent size between days (e.g. Sarcoma)
    1. Some benign masses (e.g. Ganglion Cysts, Hemangiomas) fluctuate in size
  4. Soft Tissue Masses in childhood
    1. Children are less likely to have Lipomas or Sebaceous Cysts

V. Exam

  1. Palpate lesion for size, mobility, consistency and attachment to deep structures

VI. Imaging

  1. Ultrasound (POCUS or formal Ultrasound)
    1. High frequency linear probe
    2. Identifies tumor size, margins, depth, vascularity and consistency (e.g. cystic)
    3. Excellent first line, low cost study that can expedite evaluation (esp. POCUS)
  2. MRI
    1. Most accurate imaging modality to evaluate Soft Tissue Masses and adjacent structures
    2. Also identifies necrosis, borders and relationship to fascial planes
  3. CT
    1. Consider in adults unable to undergo MRI
    2. Offers less soft tissue definition than MRI, but can identify bone and vessels, lesion density, calcifications

VII. Evaluation

  1. Refer suspicious lesions for further evaluation (e.g. needle core biopsy)
  2. Typical benign lesions may be excised per patient preference
    1. Send excised lesions for pathology

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