Good question... Kidsfeet is right. If it's benign, you can manage it surgically (biopsy, excis, recon, etc) with follow up (body scan, repeat imaging, etc) or conservatively. You want to do whatever the oncologist, radiologist, etc reasonably recommend to you. You have to go read case reports/series on the tumor, read larger studies if you can find them (unlikely for most), etc.
If it's malignant (any grade, but esp high grade malignant or malignant in peds), I'd say punt as fast as you can. You should be getting an oncology consult for all but the most clearly benign adult tumors just to CYA. For malignant ones, if there's an
ortho oncologist in your area (we are fortunate in East Det Metro... I think there's only 50-75 in the country, and we have a
very good one, who we even get to rotate with), then that's really the gold standard for ultimate mgmt of
osseous malignancies. If not, maybe just send to the best local surg oncologist... or think about a tertiary referral.
Supposing you are practicing on an island in podunk, USA with no surg onc (just heme/onco or something) and you have good training, then you
could manage a lower grade bone malignancy surgery. Still, many hands makes the casket lighter... you always want to CYA in my opinion. In that situation, I'd probably make the tertiary referral and tell the patient to "drive to the big city," though. High grade malignancy? No question.
Baiscally, in my eyes (pgy2, but a pretty brash one at that), the times to punt are the following:
-whenever you're beyond your comfort zone (back to the 4 pillars of good surgeons: ed/training, interest/motivation, hand skills, and balls)
-high energy trauma (depends on your training, but watch out for high energy fx that are doomed to bad results and/or borderline outta scope)
-malignancies or agressive benign stuff (explained above)
-peds cases (this is mostly a medical-legal thing, a financial loss, saving your sanity with crazy parents, and usually a training thing also)
...Punting doesn't have to mean to a non-DPM, but it usually does. The major, major trauma usually goes to ortho trauma (who gets paid to take call and carrys badass malpractice to cover themself). The tumors usually to surg onc (ortho onc if available since there's no organs like a liver or lung in the foot). The peds usually go to pedi ortho. If there's a skilled DPM in your area who focuses on the type of cases you are about to punt, then that's an option. FYI, those DPMs are typically in academic centers where they have a lot of research/experience to stand on... and they are also usually hospital employees with a team of super lawyers to minimize their risk, relative to everyday Joe Private Practice, DPM.
...Don't forget that America runs on money and lawyers. It might be fun for your ego (or even good for pts) to stick your neck out, but Dewey, Cheadum, and Hau Law Firm will always be waiting to drop the guillotine. You sometimes have gotta decide (unless you are a real academic bubble DPM) if the ego trip of doing a tough, tough case is potentially worth losing your beach house... or worse
