Surgical excision is certainly one of the options for lesions of 4cm. The nature of the tumour needs to be confirmed if one adopts expectant treatment. If it is a benign tumor, the consequence is progressive increase in size that may entail a bigger incision, more operative time and higher chance of bleeding when surgery is performed. If it is malignant and overlooked, then the tumor may spread locally or to distant organs rendering control and cure difficult or impossible.