Orthopaedic neoplasm surgery presents some of the most challenging clinical and ethical decisions in musculoskeletal care. The stakes are high not only due to the biological behaviour of bone and soft tissue tumours, but also because of the irreversible consequences of a misstep. Informed decision-making, meticulous planning, and interdisciplinary communication are essential but so is a deep awareness of the medico-legal landscape that surrounds every incision and diagnosis.