Abstract
Introduction: Acral sarcomas present as small tumours to specialised orthopaedic services. There is a high incidence of inadequate resection compromising clinical and functional outcome.
It is advised that lumps which are greater than 5cm should be referred to a sarcoma centre for management and that small lesions cause less harm with unplanned excision.
Method: Data from the Oxford Registry was collated of all those patients with acral sarcomas who underwent surgery in a period from 1997 – 2008 at The Nuffield Orthopaedic Centre including site, size, histological subtype, of tumours, history of previous surgical excisions, staging, and functional scores.
Results: 27 patients were treated (17 foot and ankle cases, 10 hand tumours). The commonest acral lesions were synovial sarcomas (30%).
Of the hand patients 7 of the 10 patients had wide excision of the lesion with 3 an amputation. 5 of the cases were for inadequate previous excision (50%).
7 of the 17 in the foot and ankle group underwent amputation (41%) the rest wide excision. 29% of cases were for second time surgery due to inadequate previous excision.
Discussion: Our study shows that up to 50% of patients with acral tumours are undergoing further surgery due to previous inadequate excision. The belief that 5cm should be a benchmark for specialist referral should not be applied to such lesions.
Correspondence should be addressed to BOOS at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE, England.
