A hard, fixed mass on the chest wall is usually considered to be malignant. Of 24 such lesions we have evaluated in children, only eight (33%) were malignant. Six of the eight children with malignant masses died of the disease. Benign lesions were often indistinguishable from malignant lesions by physical or roentgenographic examination, and histologic diagnosis was often difficult. Small lesions could be excised en bloc without significant deformity. Seven masses were the product of indolent infection, indicating that cultures should be obtained. Larger lesions should have adequate biopsy to direct the proper sequence of subsequent radical operation, irradiation, and chemotherapy. The defect created by radical operation is closed with polypropylene mesh and/or flap coverage. With this graded approach, the majority of children with chest wall lesions will survive with minimal deformity.