This learning module describes how to proceed after a malignant tumor is excised incompletely or without proper planning.
When a lump or bump on the foot has been surgically removed and is discovered after the fact to be cancerous, specific management steps must be taken that have the potential to optimize the patient's chance for a cure. The data on outcomes of these cases is presented.
Studies of patients following unplanned or inadequate excision of a soft tissue sarcoma show that a favorable outcome may still be achieved if additional surgical treatment is initiated without delay. However, unplanned removal of soft tissue sarcoma is associated with a higher risk of positive margins and local recurrence, both of which are associated with poor outcomes. Management of these cases requires complete excision of the entire tumor bed and any surgically contaminated tissues to achieve a wide margin. If the initial surgery resulted in extensive contamination of surrounding structures, amputation may be necessary to achieve local control. Following repeat excision in cases without clinically palpable residual tumor, 50% of the cases were found to have microscopic residual tumor. Following repeat excision, 85% of the patients were alive and disease free at 5 years. (4)
