Soft tissue tumour excision is an operation to remove a lump or mass from the soft tissues (muscle, fat, or connective tissue). Most soft tissue lumps are benign (such as lipomas), but excision may be recommended for diagnosis, symptom relief, or if malignancy is suspected.
An incision is made over the lump. The tumour is carefully dissected from the surrounding tissues and removed, ideally with a margin of normal tissue if malignancy is suspected. The specimen is sent for pathological examination. The wound is closed with stitches. The operation takes 30 minutes to two hours depending on size and location.
Excision is recommended for enlarging lumps, lumps causing pain or functional limitation, lumps where the diagnosis is uncertain, and confirmed or suspected sarcomas (malignant tumours). Any lump that is deep to the fascia, larger than 5 cm, or increasing in size should be investigated.
Observation may be appropriate for small, superficial, asymptomatic lumps that are clinically consistent with a lipoma. Imaging (ultrasound, MRI) can help characterise the lesion. Biopsy may be performed first if the diagnosis is uncertain.
MRI and/or ultrasound to characterise the lesion. If malignancy is suspected, the case should be discussed at a specialist multidisciplinary team meeting. The surgical approach is carefully planned.
Complete removal of the lump with definitive histological diagnosis. For benign lesions, excision is usually curative. For malignant lesions (sarcomas), surgery is the primary treatment and may be combined with radiotherapy.
A scar proportional to the size of the lump.
Expected around the surgical site.
A collection of fluid may accumulate after removal of a large lump.
Nerves near the tumour may be damaged during excision, causing numbness or weakness.
Wound infection.
Benign lesions may occasionally recur. Sarcomas have a risk of local recurrence depending on margins achieved.
Blood collection requiring drainage.
If the tumour is within or adjacent to a muscle, some weakness may result.
Local, regional, or general anaesthesia depending on the size and location.
Recovery depends on size and location. Small superficial excisions heal within two weeks. Larger or deeper excisions may require several weeks of rehabilitation. Physiotherapy may be needed if the excision involved muscle tissue.
Histology results at two weeks. Further follow-up depends on the diagnosis. Malignant lesions require long-term surveillance.
Warning features include a lump that is deep to the fascia, larger than 5 cm, increasing in size, painful, or fixed to surrounding structures. Any lump with these features should be assessed by a specialist.
Soft tissue sarcomas are rare. If diagnosed, treatment is planned by a specialist multidisciplinary team and typically involves surgery with or without radiotherapy.