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Which Patients With Basal Cell Carcinoma May Be Appropriate Candidates for Watchful Waiting?

By: Julia Fiederlein
Posted: Tuesday, November 16, 2021

There are limited data regarding the use of watchful waiting in patients with basal cell carcinoma; however, according to Satish F.K. Lubeek, MD, PhD, of Radboud University Medical Center, Nijmegen, the Netherlands, and colleagues, it may be an appropriate approach for those with a limited life expectancy and asymptomatic nodular or superficial tumors. The results of this observational cohort study were published in JAMA Dermatology.

Between January 2018 and November 2020, watchful waiting was initiated for 280 basal cell carcinomas in 89 patients. The investigators used linear mixed models to estimate tumor growth and identify covariates associated with tumor growth. Follow-up data were provided for a median of 9 months.

In the majority of patients (83%), patient-related factors or preferences, such as prioritizations of comorbidities, severe frailty, or limited life expectancy, were cited as reasons to initiate watchful waiting; a total of 55% of patients initiated watchful waiting due to tumor-related factors. Circumstantial and treatment-related reasons were important for 46% and 35% of patients, respectively.

Less than half of tumors (47%) increased in size. Tumor growth seemed to be associated with the basal cell carcinoma subtype (odds ratio = 3.35; P = .005); however, it did not appear to be associated with the initial tumor size and location. In patients with tumors containing at least an infiltrative or micronodular component, the estimated increase in tumor diameter was 4.46 mm after 1 year; an estimated increase in tumor diameter of 1.06 mm was reported in those with nodular, superficial, or clinical basal cell carcinoma. The most common reasons to initiate treatment were tumor burden or potential tumor burden, resolved reason(s) for watchful waiting, and reevaluation of patient-related factors.

“Patients should be followed up regularly to determine whether a watchful waiting approach is still suitable, whether patients still prefer watchful waiting, and to reconsider consequences of treatment and refraining from treatment,” the investigators concluded.

Disclosure: For full disclosures of the study authors, visit jamanetwork.com.



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