Dr. Suraga Belakawadi Surgical Oncologist

Soft tissue sarcomas and skin cancers

Sarcomas are rare cancers of fat, muscle and other connective tissue. Skin cancers include melanoma and the more common non-melanoma types. For both, the first operation matters most.

What are soft tissue sarcomas?

Sarcomas are uncommon cancers of the body’s supporting tissues. They can appear almost anywhere. They are most often found in the thigh, arm, trunk, or deep in the abdomen, in an area called the retroperitoneum.

Warning signs

  • A lump that is getting bigger
  • A lump larger than a golf ball (about 5 cm)
  • A lump that is deep, under the muscle
  • A lump that is painful
  • For tumours deep in the abdomen: swelling, a feeling of fullness, or vague discomfort

Why the first step matters

A sarcoma should be biopsied and operated on as part of a planned treatment. If a lump is removed as a simple “lump removal” without the right scans, cancer cells can be left behind. That makes later treatment harder. Scans and the biopsy route should be planned by the surgeon who will do the final operation.

How it is diagnosed

  • MRI scan for lumps in the limbs and trunk, and CT scan for tumours in the abdomen
  • Core needle biopsy, planned so the needle track can be removed at surgery
  • CT scan of the chest, to check the lungs

Treatment

  • Surgery removes the tumour with a margin of normal tissue all around it (wide local excision).
  • Radiotherapy, before or after surgery, lowers the chance of the tumour coming back in the same place.
  • Chemotherapy is used for some types of sarcoma.

Recovery and follow-up

  • Physiotherapy helps you regain strength and movement.
  • Regular scans continue for several years, because sarcomas can come back late.

Skin cancers

Types

  • Basal cell carcinoma and squamous cell carcinoma, the most common skin cancers, usually on sun-exposed skin such as the face, ears and hands
  • Melanoma, less common but more likely to spread, which can start in a mole or on normal skin, including the soles of the feet, palms and nails
  • Skin cancers that develop in old burn scars or long-standing wounds (Marjolin’s ulcer)

Warning signs

  • A mole that is new, changing in size, shape or colour, or has an irregular edge
  • A sore, lump or patch that does not heal within a few weeks, or bleeds easily
  • A dark streak under a nail that is not caused by an injury

Diagnosis and treatment

  • A biopsy confirms the diagnosis.
  • Wide excision removes the cancer with a margin of healthy skin around it.
  • For melanoma and some squamous cell cancers, a sentinel lymph node biopsy or lymph node surgery checks or treats spread.
  • Reconstruction with skin grafts or local flaps closes larger wounds and restores appearance.

Common questions

Is every lump a sarcoma?

No. Most lumps under the skin are harmless, such as lipomas (fatty lumps). A lump that is growing, larger than 5 cm, painful, or deep under the muscle should be checked with a scan before anything is removed.

Will I lose my arm or leg?

Very rarely. Most patients today have limb-sparing surgery, often combined with radiotherapy, which removes the tumour while keeping the limb working.

A lump was removed and turned out to be a sarcoma. What now?

See a cancer surgeon as soon as possible. Further surgery to clear the area, and sometimes radiotherapy, is often needed to reduce the chance of the sarcoma coming back.

How do I know if a mole is a problem?

See a doctor about a mole that is new, changing, irregular in shape or colour, larger than a pencil eraser, itchy or bleeding, or about any sore on the skin that does not heal within a few weeks.