Use of an informational video regarding low-risk basal cell carcinoma (BCC) significantly reduced patients' overall concerns (p=0.001).
Clinical Pearls
Use of an informational video regarding low-risk basal cell carcinoma (BCC) significantly reduced patients’ overall concerns (p = 0.001)
The educational video was additionally effective in decreasing specific concerns regarding tumor growth, metastasis, BCC affecting overall health, and death
The educational video had a significant effect in willingness to have BCCs monitored rather than excised among patients aged <75 years (p = 0.04)
Discussion:
Basal cell carcinoma is the most frequently observed dermatologic malignancy in the United States. Although it holds among the lowest risk for metastasis among skin cancers, it is treated via surgical excision. For patients, particularly those with low physiologic reserve, the risks of unnecessary treatment may outweigh the benefits of excision. Using a survey to assess patients’ attitudes pre- and post- video of 201 consecutive participants, this study sought to identify patient’s perspectives on active surveillance after being educated on the risks and benefits of surgical intervention vs active surveillance. The primary outcomes of this study included change in proportion of patients with concerns about monitoring BCC as well as specific concerns, and change in proportion of patients comfortable in participating in a study monitoring BCC rather than surgically treating it.
McNemar’s test for paired nominal data was used to analyze and compare categorical survey responses. The educational video was found to significantly reduce overall concerns regarding active surveillance (p = 0.001), specific concerns regarding active surveillance of BCC, as well as had a significant effect in patients willing to participate in a study that would monitor BCCs rather than treat among patients <75 years of age (p= 0.04). While this video creates an educational model for helping patients come to the right treatment decision for them, the cohort of patients included was primarily White (94%), and 41% of patients had a previous diagnosis of BCC.
Given the lack of diversity of patients being surveyed as well as a significant proportion of patients having had a prior BCC, the external validity of this study is limited. Further studies are needed to evaluate the true net benefit patients are receiving from routine surgical excision for low-risk BCCs, as well as possible benefits of active surveillance as a management approach.
Comments