Question
A 55 year old man has a painless 8 cm mass in his posterior thigh that has grown over 6 months. It is deep to the fascia.
- What features suggest malignancy?
- How would you investigate this mass?
- Outline the principles of management.
Answer
Features suggesting malignancy
- Size over 5 cm
- Deep to the deep fascia
- Increasing size
- Pain
- Recurrence after previous excision
Investigations
- MRI of the thigh before any biopsy
- Referral to a sarcoma service
- Core needle biopsy at the sarcoma centre, along the line of the planned excision
- CT of the chest for staging
- Common subtypes are undifferentiated pleomorphic sarcoma, liposarcoma, myxofibrosarcoma and synovial sarcoma
Management principles
- Avoid unplanned excision (the whoops procedure), which contaminates tissue and compromises limb salvage
- Wide excision with a cuff of normal tissue
- Radiotherapy, given before or after surgery, for high grade, deep or large tumours, with preoperative radiotherapy causing more wound complications but less fibrosis
- Chemotherapy for selected subtypes such as synovial sarcoma and rhabdomyosarcoma
- Follow up for local recurrence and lung metastases
Related pages
Author Contributions
Orthofracs team
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.