# Benign musculoskeletal neoplasm - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class LD26.00 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · Pancreatic Ascites(Archived) - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK507851/ - Verified date: 2026-08 ## Verified against - No dose - referral pathway, no medicine given in primary care ## Treatment metadata - No drug therapy in primary care (Recognition & Referral) ## Complete treatment card ```text BENIGN MUSCULOSKELETAL NEOPLASM Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class LD26.00 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · Pancreatic Ascites(Archived) - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK507851/ Review status: REVIEWED against the source listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (7) - Most are picked up by chance on an x-ray taken for something else - Next commonest is a painless lump felt over the affected bone [skin nodule] - The lump can look unsightly where bone is close to the skin, as at the upper shin or ribs - Pressure on a nerve gives tingling and numbness [numbness · tingling] - Pressure on a vessel alters skin colour, pulses or blood flow - A lesion sitting under a tendon causes tendon pain and irritation on movement - Hereditary multiple exostoses is silent in newborns; half have a visible tumour by 5 and 80% by 10 SIGNS - what you find (9) - Absent pulses or colour change downstream of the lesion - Arterial or venous clot, aneurysm or false aneurysm can develop - The knee is the usual site, catching the popliteal artery and the peroneal and posterior tibial nerves - Soft tissue squeezed by the lesion can raise a bursa and inflame it - Lesions beside the discs can produce kyphosis or spondylolisthesis; cord compression is rare - Multiple exostoses bring valgus deformities: ankle valgus, knock knee, coxa valga - Also unequal limb length, sideways deviation at the wrist, and short hand or foot bones - Multiple exostoses may bring hip socket dysplasia, hip impingement or juvenile arthritis - Dislocation or partial dislocation of hip, kneecap or talus is common in multiple exostoses TESTS (12) - X-ray: a surface lesion at the metaphysis whose cortex and marrow run on from the parent bone, capped by cartilage - Broad-based sessile or narrow-stalked pedunculated; the stalked ones point away from the joint - The cartilage cap does not show on plain film and shrinks once growth finishes - Broad-based lesions carry the higher risk of turning malignant - Worrying x-ray changes: the lesion grows, changes shape, shows periostitis, or its cortical edge blurs - Scapula, pelvis and spine lesions are often unclear on film and need further imaging - CT or MRI when the x-ray suggests malignant change - Cap thickness: 1 to 3 cm while still growing, only millimetres once mature - A cap over 2 cm in a fully grown patient is worrying and needs tissue sampling - MRI shows an overlying bursa as a well-defined bright fluid collection - With neurological signs, MRI may show the nerve pushed aside, swollen or bright, and its muscles swollen or fatty - Bone scan does not help: benign and malignant lesions both light up IF NOT THIS - what else fits (10) - Subungual exostosis, on the back of the end finger bone near the nail, often painful with skin ulceration - Subungual exostosis is also a surface lesion but has no marrow continuity, and sits elsewhere - Trevor disease: several lesions off the epiphysis, usually in the legs, three boys to each girl - Trevor disease shows up young with altered gait, bone deformity or a felt mass, and never turns malignant - Turret exostosis sits outside the cortex on the back of a finger bone with no marrow continuity - Nora lesion of the hands and feet: surface lesion, no marrow continuity, no malignant risk reported - Parosteal osteosarcoma: a big lobulated dense mass on the bone surface without marrow continuity - Parosteal osteosarcoma favours the metaphysis, most often the back of the lower femur - Juxtacortical chondroma scoops out the nearby cortex with periosteal reaction, typically at ages 20 to 40 - Subperiosteal haematoma: a smooth oval surface lesion after injury, with no marrow continuity Source StatPearls "Osteochondroma" - disease-level clinical article Status traced to the source above 1. NO DRUG THERAPY IN PRIMARY CARE (RECOGNITION & REFERRAL)[1st line] Adult Benign growths such as osteochondroma usually just need monitoring; the GP recognises the mass and refers to orthopaedics only if it is symptomatic or the diagnosis is uncertain. - Refer Peds Children follow the same pathway: recognise and refer. No primary-care medicine is implied. Source No dose - referral pathway, no medicine given in primary care Why Benign growths such as osteochondroma usually just need monitoring; the GP recognises the mass and refers to orthopaedics only if it is symptomatic or the diagnosis is uncertain. Caution Rapid growth, new pain, features suggesting malignant change, nerve or vessel compression. No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to. 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