Bone Lesions: Benign and Malignant

• Most primary bone tumors develop in the second decade of life (during the growth spurt). • Most primary bone lesions are metaphyseal. • A plain radiograph may be diagnostic in many tumors (especially benign lesions that have a characteristic appearance and site) and is a good starting point in the evaluation of focal bone lesions. • CT scan may yield additional diagnostic information for very small lesions or in cases that have confusing radiographic findings. • Both osteosarcoma and Ewing sarcoma metastasize to the lungs. • Staging studies, including MRI of the local site, should be performed before any biopsy. • Bone lesions should be biopsied in a center that has experience in the diagnosis and management of bone tumors. • Limb salvage should be attempted and is possible in most bone malignancies. • Most benign bone lesions can be managed conservatively with observation. Occasionally, curettage or excision may be required for large lesions, those proximal to a joint, or those that have premalignant features. Lesions involving more than 50% of the bone diameter may require curettage and bone grafting due to the risk of pathologic fracture.