What are the referral guidelines for soft tissue masses?

Soft tissue lumps are common: malignant ones are rare, but detecting them early is important. Delay in diagnosis is a significant problem in the treatment of sarcomas, as is unplanned excision. An unplanned excision occurs when a soft tissue lump is removed by a surgeon (or General Practitioner) without any thought about whether the lump might be malignant. (these are called “whoops” operations by sarcoma teams). Both of these problems can be minimised by using the referral guidelines.

A soft tissue lump exhibiting any of the following four following criteria should be considered malignant until proven otherwise:

  1. increasing in size
  2. size >5cm
  3. deep to the deep fascia
  4. painful

Patients with lumps such as these are best referred to a specialist centre for further investigation, which would start with imaging (eg USS or MRI).

UK soft tissue sarcoma guidance can be found here.

Guidance for referral to the London Sarcoma Service can be found here.

The North of England Bone and Soft Tissue Tumour Service has a fax for urgent referrals: 0191 223 1328.

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