Soft Tissue Mass

Aka: Soft Tissue Mass, Soft Tissue Growth, Soft Tissue Neoplasm, Skin Mass, Skin Lump, Subcutaneous Mass

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II. Causes: Benign Soft Tissue Mass

  1. General
    1. See Skin Nodule
    2. Lymphadenopathy
    3. Hematoma
    4. Lipoma
    5. Sebaceous Cyst (Epidermal Inclusion Cyst)
    6. Common Wart or Molluscum Contagiosum
    7. Dermatofibroma
    8. Foreign Body Granuloma
  2. Scalp
    1. See Scalp Dermatitis
    2. Pilar Cyst (Trichilemmal Cyst)
    3. Keloid
  3. Hands and Feet
    1. Digital Mucous Cyst
    2. Ganglion Cyst
    3. Morton's Neuroma
    4. Plantar Fibroma
    5. Tenosynovial Giant Cell Tumor (Giant cell tumor of tendon sheath)
    6. Foot Schwannoma
  4. Muscle
    1. Myositis Ossificans
    2. Intramuscular Myxoma
    3. Smooth Muscle Hamartoma
  5. Vascular
    1. Cystic Lymphangioma, Capillary Lymphangioma or Cavernous Lymphangioma
    2. Hemangioma
    3. Pyogenic Granuloma
    4. Nodular Vasculitis
  6. Rheumatologic
    1. See Cutaneous Signs of Rheumatic Disease
    2. Rheumatoid Nodule
    3. Gouty Tophi
    4. Erythema Nodosum
    5. Polyarteritis Nodosa
  7. Infectious
    1. Skin Abscess
    2. Nodular Lymphangitis
    3. Tuberculous Lymphadenitis
    4. Mycetoma
  8. Congenital
    1. See Cutaneous Signs of Dysraphism
    2. See Neurocutaneous Syndrome (e.g. Neurofibromatosis)

III. Causes: Malignant Soft Tissue Mass

  1. Sarcoma
    1. Dermatofibrosarcoma Protuberans
    2. Leiomyosarcoma
    3. Liposarcoma
    4. Rhabdomyosarcoma
    5. Synoviosarcoma
  2. Other malignancy that may involve soft tissue
    1. Lymphoma
    2. Squamous Cell Carcinoma
    3. Basal Cell Carcinoma
    4. Melanoma

IV. Precautions: Red flags for Malignancy

  1. Firm, deep masses adherent to adjacent structures
  2. Large lesions >5 cm in diameter (golf ball size)
    1. Accounts for 90% of malignant lesions
    2. However, diameter <5 cm does not exclude malignancy
  3. Consistent size between days (e.g. Sarcoma)
    1. Some benign masses (e.g. Ganglion Cysts, Hemangiomas) fluctuate in size
  4. Soft Tissue Masses in childhood
    1. Children are less likely to have Lipomas or Sebaceous Cysts

V. Exam

  1. Palpate lesion for size, mobility, consistency and attachment to deep structures

VI. Imaging

  1. Ultrasound (POCUS or formal Ultrasound)
    1. High frequency linear probe
    2. Identifies tumor size, margins, depth, vascularity and consistency (e.g. cystic)
    3. Excellent first line, low cost study that can expedite evaluation (esp. POCUS)
  2. MRI
    1. Most accurate imaging modality to evaluate Soft Tissue Masses and adjacent structures
    2. Also identifies necrosis, borders and relationship to fascial planes
  3. CT
    1. Consider in adults unable to undergo MRI
    2. Offers less soft tissue definition than MRI, but can identify bone and vessels, lesion density, calcifications

VII. Evaluation

  1. Refer suspicious lesions for further evaluation (e.g. needle core biopsy)
  2. Typical benign lesions may be excised per patient preference
    1. Send excised lesions for pathology

VIII. References

  1. Achar (2022) Am Fam Physician 105(6): 602-12 [PubMed]

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