Bone tumours and tumour-like conditions present a diverse spectrum of lesions requiring precise diagnosis and multidisciplinary management. This chapter provides a surgical overview of their evaluation and treatment, emphasizing oncological safety, functional preservation, and reconstruction. Clinical assessment, appropriate imaging, and biopsy planning are essential for accurate diagnosis and staging. Surgical management is guided by Enneking’s principles, with limb-salvage now preferred over amputation owing to advances in chemotherapy, imaging, and reconstruction. Options include endoprostheses, biological grafts, and vascularized fibular transfers tailored to patient factors. Tumour-like lesions such as fibrous dysplasia and aneurysmal bone cysts are managed with curettage and grafting, with adjuvants reducing recurrence. Multimodal therapy incorporating chemotherapy and radiotherapy enhances survival and local control in malignant cases. Evolving reconstructive techniques, including computer-assisted and 3D-printed implants, continue to improve outcomes. Successful management integrates oncological precision with functional restoration through coordinated multidisciplinary care.