Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with a slowly enlarging, firm, subcutaneous nodule on the [location: e.g., volar aspect of the distal forearm/hand]. The lesion has demonstrated [duration] of growth, with recent development of overlying skin ulceration and intermittent serosanguinous discharge. Patient denies constitutional symptoms but reports localized tenderness and occasional paresthesia in the distribution of the [nerve: e.g., median/ulnar] nerve. No history of antecedent trauma.
Clinical Examination Findings
Inspection of the [location] reveals a [size: e.g., 2.5 cm] firm, multinodular mass fixed to the deep fascia. Overlying skin shows [ulceration/erythema/induration]. Palpation confirms a non-mobile, painless to mildly tender lesion. Neurovascular status: [distal pulses intact/diminished], capillary refill <2 seconds. Sensation intact to light touch in all digital distributions. No palpable regional lymphadenopathy in the axilla or epitrochlear region.
Treatment Protocol
Recommended management includes wide local excision with clear surgical margins. Given the high risk of local recurrence and regional lymph node metastasis, sentinel lymph node biopsy or regional lymphadenectomy may be indicated. Post-operative adjuvant radiotherapy is planned to minimize local recurrence. Referral to oncology for systemic staging (MRI/PET-CT) and multidisciplinary tumor board review is mandatory.