Patient-related factors influence watchful waiting approach for basal cell carcinoma

Frailty and comorbidities were some of the patient-related factors that drove patients to choose a watchful waiting approach to basal cell carcinoma, according to a study.

“Few studies have examined watchful waiting in patients with basal cell carcinoma (BCC), although this approach might be suitable in patients who might not live long enough to benefit from treatment,” Marieke E. C. van Winden, MD, MSc, of the department of dermatology at the Radboud Institute for Health Sciences at Radboud University Medical Center in Nijmegen, the Netherlands, and colleagues wrote.

In the current observational cohort study, researchers determined reasons physicians and patients chose watchful waiting and documented the natural course of BCC disease in those patients. They also determined the reasons given for later initiation of treatment.

The study was conducted at a single institution between January 2018 and November 2020. Eligible participants had one or more BCC malignancies that were not treated for 3 months or longer.

Results showed that 89 patients (53% men; median age, 83 years [interquartile range, 73-88]) with 280 carcinomas chose watchful waiting, with a median follow-up duration of 9 months (IQR, 4-15).

For 83% of the group, watchful waiting was chosen due to patient-related factors such as comorbidities, frailty or limited life expectancy. For 55% of patients, tumor-related factors were cited as the reason for watchful waiting, including absence of symptoms and the indolent nature of BCCs.

Importance was placed on treatment-related factors by 35% of patients, while 46% reported that circumstantial reasons, such as planning or transportation difficulties, influenced their decision to choose watchful waiting.

Less than half of tumors (46.8%) increased in size during watchful waiting. BCC subtype carried an association with tumors that grew (OR = 3.35; 95% CI, 1.47-7.96; P = .005). However, tumor size and location failed to influence growth.

For tumors containing at least an infiltrative/micronodular component, an estimated diameter increase of 4.46 mm (80% prediction interval, 1.42-7.46) was reported at 1 year. For the remaining malignancies, an increase of 1.06 mm (80% PI, 1.79 to 4.28) was observed at 1 year.

Tumor burden or potential tumor burden were the most cited reasons to initiate treatment, in addition to reevaluation of patient-related factors.

“In this cohort study of patients with BCC, [watchful waiting] was an appropriate approach in several patients, especially those with asymptomatic nodular or superficial BCCs and a limited life expectancy,” the researchers wrote.

The researchers recommend patients should regularly follow up to assess whether a watchful waiting approach is still appropriate and to reconsider treatment consequences.