For Medical Professionals

Clinical Referral Guide: Evaluation of Suspicious Soft Tissue Masses

This guide is intended for General Practitioners and Surgical Colleagues to streamline the referral process for suspected sarcomas and prevent the complications associated with unplanned excisions.

1. The "Red Flag" Criteria (The Rule of 5s) Consider an urgent referral to a musculoskeletal oncologist for any soft tissue mass that meets the following criteria:

Size: Larger than 5 cm (approximately the size of a golf ball).
Depth: Deep-seated (deep to the muscle fascia).
Growth: Any mass that is rapidly increasing in size.
Recurrence: Any mass that has recurred after a previous excision.
Pain: While many sarcomas are painless, a deep, aching pain can be a sign of rapid growth.

2. The Critical "Don'ts" Before Referral To ensure the best patient outcome and preserve limb salvage options:

DO NOT perform a needle biopsy or "shell-out" excision in the primary care setting. Incorrect biopsy tracks can contaminate surgical planes and necessitate more radical resections.
DO NOT assume a mass is a simple lipoma based solely on its slow growth or painless nature.
DO NOT use ultrasound as the definitive diagnostic tool; Contrast-enhanced MRI is the gold standard for evaluating STS.

3. Streamlined Referral Information To expedite the multidisciplinary team (MDT) review, please include:

Recent imaging reports (MRI preferred).
History of growth and any previous surgical interventions.
Patient's functional status and significant comorbidities.

Multidisciplinary Excellence in Sarcoma Management: A Message to Colleagues

As a musculoskeletal oncologist with over 25 years of clinical and academic experience, I recognize that the successful management of bone and soft tissue sarcomas is rarely a solo endeavor. It requires the seamless convergence of surgical precision, radiological insight, and pathological expertise.

My practice is built on a Multidisciplinary Team (MDT) philosophy. We prioritize centralized care hubs where complex cases are reviewed collectively to optimize local control and survival rates. This collaborative approach is particularly critical in managing soft tissue sarcomas (STS), where achieving oncologically safe margins while preserving critical structures is the primary goal.

Key pillars of my professional approach include:

Precision Surgical Oncology: Utilizing specialized techniques to minimize the risk of "unplanned excisions" and managing contaminated margins with radical yet functional reconstructive solutions.
Translational Research Integration: Drawing on my background in molecular chemosensitivity and tumor angiogenesis to inform clinical decision-making for high-grade lesions.
Innovation in Limb Salvage: Implementing advanced technologies such as 3D-printed custom implants, cryosurgery, and biologic reconstructions to provide durable, site-specific solutions for "salvage" scenarios.

I am committed to working closely with referring physicians to ensure that patients with suspicious masses receive an expert oncological evaluation at the earliest possible stage. By adhering to standardized international clinical protocols, we can collectively ensure that the treatment offered in Singapore remains at the forefront of global standards.

Professional Referrals & Consultations

To ensure the timely evaluation of urgent sarcoma cases or to discuss a complex limb salvage reconstruction, medical practitioners may reach out via the following dedicated channels:

Clinical Referrals: Direct referrals for suspicious soft tissue masses or bone lesions can be made through our central clinic line at +65 6735 5576.
Case Discussions: For peer-to-peer discussion regarding complex "unplanned excisions" or contaminated margins, please contact us at info@limbsalvagesurgery.com.
Imaging Review: We offer expert radiological review for overseas or local cases requiring specialized musculoskeletal oncological insight prior to biopsy.

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