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 afte r shelling out a ''lump''. Many times these apparently unexpected enco unters are followed by an incomplete excision which is, in turn, follo wed by one or more local recurrences. Repeat operations are often ampu tations of increasing magnitude, and are not infrequently followed by the death of the patient. The hand is a site in which a patient usuall y presents for evaluation of a swelling when it is quite small. For th e patient with a sarcoma, initial adequate surgery offers the best hop e of cure. Why are these relatively uncommon tumours of such interest and importance? They frequently afflict young, productive patients. Wh en treated late or inadequately, they can result in tremendous sufferi ng. In recent years there has been considerable progress made in the t reatment 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.