Patient Preferences and Cosmetic Outcomes Following Destructive Treatments for Non-facial Basal Cell Carcinoma: A Mixed Methods Study

Abstract

The high prevalence of basal cell carcinoma (BCC) entails a substantial burden on healthcare systems. Interest in non-surgical treatment methods for low-risk BCCs, including destructive treatments, is increasing. Dermatologists often highlight suboptimal cosmetic outcomes as drawbacks of destructive treatments, also for non-facial lesions. Patient perspectives regarding scarring and cosmetic outcomes in relation to other relevant factors are largely unknown, yet important to consider in shared decision-making when choosing treatment. This study investigates patient perceptions of scarring following destructive treatments and explores important factors in treatment decisions for non-facial BCCs. Through a mixed-methods design, cosmetic outcomes, patient satisfaction, scarring concerns, and treatment preferences were evaluated within an ongoing randomized clinical trial on destructive treatments for low-risk BCCs. Overall, 157 patients with 425 non-facial scars were assessed. Most patients were not concerned about scar appearance, highlighting a discrepancy compared with dermatologists' general concerns regarding inferior cosmetic outcome. Instead, when opting for specific treatments, patients listed clearance rates as the most important factor, followed by convenience and time consumption. We believe the results are important both in the context of patient-centred care and in "choosing wisely" when deciding between BCC treatments.

Fig. 1

Overview of the randomized controlled trial with performed procedures/evaluations. Cur: curettage; cryo: cryosurgery; ED: electrodesiccation; FU: follow-up visit; nBCC: BCC with nodular features; sBCC: superficial BCC; vs: versus.

Fig. 2

(A) Patient satisfaction with the scars and (B) patient concerns about the scars (mean and 95% confidence interval), stratified by sex and age groups. Lower scores indicate a more positive evaluation of the scars.

Fig. 3

Patients’ ranking of factors of importance when choosing treatment methods for basal cell carcinoma. 1, most important; 2, second most important; 3, third most important; 4, least important.