Sarcoma (Ewing/Rhabdo)

Patients requiring surgical intervention for circumcision include infants over 3 months of age or weighing more than 13 pounds, who cannot safely undergo office circumcision. Additionally, patients with isolated chordee without hypospadias benefit from operative circumcision to release adhesions and straighten the penis. Conversely, elective circumcision in infants under 3 months should not require general anesthesia due to anesthetic safety concerns.

Diagnosis of soft tissue sarcomas (rhabdo and non-rhabdo) involves imaging and tissue sampling. The workup includes MRI and either incisional or core biopsy. Histological grade is critical in non-rhabdomyosarcoma soft tissue sarcomas for treatment decisions. For regional disease assessment, sentinel node biopsy is performed because clinically negative nodes may harbor occult disease; 40–50% of biopsied nodes are positive, and positive nodes carry worse prognosis and require radiation therapy.

Todd Ponsky discussed surgical decision-making for non-rhabdomyosarcoma soft tissue sarcomas. He presented a study comparing outcomes between patients who had unplanned excision of lesions later found to be non-rhabdomyosarcoma followed by re-excision versus those with planned workup and excision. The study involved 40 patients referred after innocuous lesion removal that returned as non-rhabdomyosarcoma. Ponsky concluded that since there is no outcome difference between planned and unplanned excision, it may be acceptable with low index of suspicion to excise the lesion and perform re-excision if it returns as non-rhabdomyosarcoma.