Basal cell cancer, the most common form of skin cancer, does not always have to be removed immediately. So-called watchful waiting, where a doctor does not treat the tumor but checks regularly, may be a good option for some patients. This is the result of research by Satish Lubeek and Marieke van Winden and their team from Radboudumc, the hospital reports.
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Basal cell carcinoma mainly occurs in older patients with a light skin color. Usually on parts of the body that are exposed to a lot of sun, such as the head and neck, but also, for example, on the torso. Every year, tens of thousands of patients in the Netherlands develop a basal cell carcinoma. This skin cancer grows slowly, rarely metastasizes and is almost never life-threatening. The treatment is relatively simple: removing the tumor. This is cheap and involves little risk. Then why would you want to wait to treat?
“People have various reasons not to immediately plan an operation,” answers Marieke van Winden, a dermatologist in training at Radboudumc and first author of the article. “For example, because of a short life expectancy or poor health. Also, a tumor sometimes gives little complaints and grows very slowly. Or people are afraid of the burden and the aftermath of a treatment. But until now, little was known about the consequences of waiting, which makes it difficult for dermatologists to give advice. We have now investigated this.”
Decide together
For the study, the research team followed 280 tumors in 89 patients. The patients came for a check-up every three months. Sometimes the doctor and patient decided together to remove the tumor after all. This generally happened after seven months. In almost all cases this was still possible in exactly the same way as at the start of the process, even if the tumor had grown slightly. Especially for a certain subtype of basal cell carcinoma, namely nodular and superficial basal cell tumors, doctors may consider waiting or forgoing treatment more often. In this study, these tumors were found to grow on average only 1 millimeter per year. This makes them seem like a good candidate for watchful waiting.
According to Van Winden, the choice of whether or not to treat immediately is a good example of personalized care. “A doctor makes the consideration: what are the consequences of 1 to 2 millimeters of growth per year? It matters where the tumor is. With one eye, 1 millimeter of growth can already be a lot, while on the back it often makes little difference. A doctor always decides together with the patient. Some people want you to remove a tumor as soon as possible. Another says: ‘Is all that still necessary at my age?’ and would rather wait. In this way we arrive at affordable and sensible care together.”
By: National Care Guide
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