Marieke van Winden MD MSc PhD candidate Dermatology Radboud Institute for Health Sciences Department of Dermatology Radboud University Medical Center Nijmegen, the Netherlands

Basal Cell Skin Cancer: Watchful Waiting Better for Some Frail, Elderly Patients Interview with:

Dr. van Winden

Marieke van Winden MD MSc
PhD candidate Dermatology
Radboud Institute for Health Sciences
Department of Dermatology
Radboud University Medical Center
Nijmegen, the Netherlands What is the background for this study? What underlying conditions would factor in a decision for Watchful Waiting? 

Response: Basal cell carcinomas are frequently treated because of the risk for progression, which can cause a significant morbidity due to local tissue invasion and destruction. However, most BCCs are characterized by a relatively indolent nature, growing slowly and frequently asymptomatically.

Because patients with a limited life expectancy might not live long enough to develop symptoms from basal cell carcinoma progression, they might not live long enough to benefit from treatment. Underlying conditions that determine life expectancy should therefore be considered when weighing BCC management options. When life expectancy is expected to be relatively short, and the consequences of  watchful waiting (WW) are relatively low risk (low tumor burden expected within the remaining lifespan), WW should be considered. What are the main findings?

Response: Patient-related factors (e.g. frailty, comorbidities and limited life expectancy) were important factors for patients to choose watchful waiting. A slight majority of tumors did not increase in size during follow-up, although infiltrative/micronodular basal cell carcinomas showed a significant risk for tumor growth compared to nodular/superficial basal cell carcinoma . What should readers take away from your report?

Response: Consider watchful waiting as part of basal cell carcinoma management, discuss watchful waiting with patients and proxies, especially in small nodular/superficial BCCs that are located outside of the facial area, or in case tumor growth is expected to be non-bothersome.

Finally, consider patient-related factors and discuss potential patient-related factors influence basal cell carcinoma management decisions in a shared decision-making manner. What recommendations do you have for future research as a result of this work?

Response: Structured, prospective research studying the natural growth of basal cell carcinoma is needed to confirm our results and to predict other factors associated with tumor growth besides tumor subtype. More research is needed on predicting life expectancy in this population and which time span is relevant for BCC symptomatology.


van Winden MEC, Hetterschijt CRM, Bronkhorst EM, van de Kerkhof PCM, de Jong EMGJ, Lubeek SFK. 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. JAMA Dermatol. Published online September 08, 2021. doi:10.1001/jamadermatol.2021.3020

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Last Updated on September 8, 2021 by Marie Benz MD FAAD