374 529 dermatologists’ perspectives on active surveillance for low-risk basal cell carcinoma

Abstract

Active surveillance (AS) might be an appropriate management option for frail older adults with low-risk basal cell carcinoma (BCC) when risks of treatment outweigh benefits. However, AS is not yet incorporated in US clinical guidelines for BCC. The goal of this study was to investigate dermatologists’ perspectives on AS, by identifying clinical scenarios in which this option would be recommended. An online survey including demographic questions and clinical scenarios was emailed to 11,476 US dermatologists in December 2021 with 2 reminders. Each clinical scenario was identical except for characteristics that randomly varied including patient age (91 or 71 years), life expectancy (healthy, 3-year- or, 1-year life expectancy), and tumor location (arm or shin). Dermatologists were asked “Which BCC management option would you recommend to this patient?”. We compared responses using logistic regression to define odds ratios. 529 dermatologists responded (4.6% response rate); 43% women, 60% general dermatologists, 12% dermatologic surgery, 63% >10 years of experience, 56% group or private practice, 20% academic. AS was the preferred choice (58% of responses) for patients with 1-year life expectancy, 38% for patients with 3-year life expectancy and 6% for healthy patients. The odds ratio comparing AS in 91- to 71-year-old patient was 1.64 (95%CI 1.27-2.12), 9.33 (95%CI 5.71-15.25) comparing 3-year life expectancy to a healthy patient and 20.44 (95%CI 12.52-33.35) comparing 1-year life expectancy to a healthy patient. No significant differences were noted when comparing tumor location on the arm to the shin. In this survey study of over 500 dermatologists, most recommended active surveillance in situations of limited life expectancy and advanced age. This may help guide clinical guidelines and future trials of active surveillance.