Evaluation of Watchful Waiting and Tumor Behavior in Patients With Basal Cell Carcinoma An Observational Cohort Study of 280 Basal Cell Carcinomas in 89 Patients
Study (n=89) found watchful waiting (WW) might be appropriate approach in patients with limited life expectancy & asymptomatic nodular/superficial disease but regular follow up needed to determine if WW still suitable/reconsider consequences of treatment & refraining from it.
Source:
JAMA Dermatology
Resource links:
SPS commentary:
Patient-related factors or preferences (i.e. prioritisations of comorbidities, severe frailty, or limited life expectancy) were reasons to initiate WW in 74 (83%) patients, followed by tumour-related factors (n = 49; 55%). The minority of tumours increased in size (47%). The most common reasons to initiate treatment were tumour burden or potential tumour burden, resolved reason(s) for WW, and re-evaluation of patient-related factors.
An editorial notes that the results of the study are encouraging but it is important to note that the authors did not perform actual active surveillance; the study did not prospectively enroll patients and see them in follow-up at set times, nor did it have prespecified end points for recommending treatment. It instead observed the reasons why patients chose to avoid or delay treatment, the course of disease during this time without treatment, and the reasons why patients later chose to treat. It suggests that before evidence-based active surveillance in basal cell carcinoma (BCC) can become a viable option, prospective studies of active surveillance, with specified follow-up times and clear outcome measures, are needed. Other key information that will inform this option includes reliable ways to identify which BCCs are low risk, how to select patients to whom to offer active surveillance, and how best to discuss active surveillance with those patients.