An approach to soft tissue sarcomas of the hand and upper limb

Referral letters and histories of patients seen for sarcomas involving their hands repeatedly describe a serious tumour found during or after shelling out a "lump". Many times these apparently unexpected encounters are followed by an incomplete excision which is, in turn, followed by one or more local recurrences. Repeat operations are often amputations of increasing magnitude, and are not infrequently followed by the death of the patient. The hand is a site in which a patient usually presents for evaluation of a swelling when it is quite small. For the patient with a sarcoma, initial adequate surgery offers the best hope of cure. Why are these relatively uncommon tumours of such interest and importance? They frequently afflict young, productive patients. When treated late or inadequately, they can result in tremendous suffering. In recent years there has been considerable progress made in the treatment of sarcomas. Early and effective treatment often allows local control of the tumour without amputation. In order to accomplish this, the approach to these patients must be cautious and precise.