Treatment

Treatment depends on the characteristics of the tumor, including:

• Depth. Tumors between layers of muscle tend to be more aggressive.
• Size. Tumors measuring 1.9 inches (5 centimeters) or more in width, length or depth may require more extensive surgery, sometimes with additional treatment, such as radiation with or without chemotherapy.
• Grade. An MFS can be either low (composed mainly of inactive rather than dividing cells, with no accumulation of dead cells); intermediate (with a higher proportion of actively dividing cells); or high (containing large numbers of dividing cells, along with dead cells). Low-grade tumors are less aggressive than intermediate- and high-grade tumors.
• Previous treatment. When MFS recurs, the second tumor often has a higher grade than the first.

MFS always requires surgery to remove the cancer and a margin of healthy tissue around it. The extent of surgery varies according to tumor size and other characteristics. Radiation therapy usually supplements surgical treatment.

• Small, low-grade, superficial tumors. If it isn't right next to a joint, a network of blood vessels or another critical structure, a small MFS just below the skin may be managed with surgery alone.
• Intermediate- or high-grade tumors. For a tumor with aggressive characteristics, pre-surgical radiation therapy can make it easier to identify the borders of the tumor so that there's a better chance of taking it out with a margin of healthy tissue. Alternatively, radiation therapy may follow surgery, with the goal of destroying cancer cells that might not have been removed. Anti-cancer drugs (chemotherapy) play a smaller role in MFS treatment than in treatment for other types of cancer.

In the past, as many as half the MFS patients were initially treated with amputation of the affected limb. Today, surgical, medical and radiation oncologists make limb preservation a priority whenever possible. In many cases, plastic surgeons also are involved in the initial surgery, laying the groundwork for reconstructive procedures to restore limb function.