Synopsis
Classify an incidental or symptomatic bone lesion by age, site, matrix and biological behaviour, protect a weakened bone and avoid an unplanned biopsy or operation that compromises tumour care.
- Most benign bone lesions are incidental, but no lesion is safely labelled from name recognition alone: integrate age, exact skeletal site, margin, matrix, cortex and symptoms.
- First-line imaging is a high-quality radiograph in two planes including the full lesion; prior films are invaluable for growth and stability.
- A narrow geographic margin, intact cortex and uninterrupted solid periosteal response favour slow behaviour, whereas a permeative margin, cortical escape and mass are aggressive.
Key red flags
Night or rest pain that is progressive and not explained by a fracture is incompatible with casual discharge of an incidental benign label.
Investigation priorities
Characterise location, margin, matrix, cortex, periosteal response and fracture and compare with prior imaging.
Management branches
A bone lesion appears unexpectedly on imaging obtained for another reason.
- Review high-quality radiographs, patient age, precise location, margin, matrix and all prior images.
- Ask directly about focal pain, growth, fracture, constitutional symptoms and relevant cancer or family history.
Key medicines
Paracetamol while lesion assessment proceedsUse 500 to 1,000 mg orally when required, separated by four hours or more and capped at 4 g in 24 hours, with a lower daily maximum for low body weight or liver risk.
Denosumab for selected giant-cell tumourSpecialist centres may use 120 mg subcutaneously on days 1, 8 and 15 of the first month and then every four weeks, with calcium and vitamin-D support according to the product licence.