Skip metastases in osteosarcoma: recent experience.

Osteosarcoma associated with a skip metastasis (SM) is a rare occurrence. The impact of modern chemotherapy on this entity has not been previously reported. This paper presents three cases treated by primary amputation and postoperative chemotherapy. All patients developed typical pulmonary and subsequent bony metastases. The average disease-free interval was 6.7 months. None appeared to benefit either from intensive chemotherapy or thoracotomy. The disease disseminated extensively in all three patients without radiologic or clinical response to the varied chemotherapeutic or additional surgical procedures. We conclude that a SM is a grave prognostic sign despite modern adjuvant modalities and suggest that a different therapeutic strategy is required.