Persistent skeletal pain and swelling, with or without limitation of motion of adjacent joints or spontaneous fracture, are indications for prompt clinical, radiographic, laboratory, and possibly biopsy examination. Radiographs may reveal the location and extent of the lesion and certain characteristics that may suggest the specific diagnosis. The so-called classic radiographic findings of certain tumors (eg, punched out areas of the skull in plasma cell myeloma (eFigure 20–30), "sun ray" appearance of osteogenic sarcoma (eFigure 20–31), and "onion peel" effect of Ewing sarcoma [eFigure 20–32]), although suggestive, are not pathognomonic. Even a bone tumor's histologic characteristics, considered in isolation, provide incomplete information about the nature of the disease. The age of the patient, the duration of complaints, the site of involvement and the number of bones involved, and the presence or absence of associated systemic disease—as well as the histologic characteristics—must all be considered for proper management.
The possibility of benign developmental skeletal abnormalities, metastatic neoplastic disease, infections (eg, osteomyelitis), posttraumatic bone lesions, or metabolic disease of bone must always be kept in mind. If bone tumors occur in or near the joints, they may be confused with the various types of arthritis, especially monoarticular arthritis.