Fixation of the tumour to underlying muscle or fascia does not carry the same poor prognosis as had been previously thought. If these patients have otherwise operable disease, they should be offered resection with an extension of the surgery to include the area of muscle involvement.

Because of muscle involvement these patients should be offered postoperative radiation therapy.

Adjuvant systemic therapy will be offered to those patients who are deemed to have risk factors for micrometastatic involvement (see Adjuvant Systemic Therapy).