Marieke E. C. van Winden, M.D., from the Radboud Institute for Health Sciences in Nijmegen, Netherlands, and colleagues conducted an observational study to examine reasons for WW and document the natural course of BCC in patients who choose WW. Overall, WW was chosen for 280 BCCs in 89 patients (median age, 83 years), with a median follow-up of nine months.

The researchers found that in 83 percent of patients, patient-related factors or preferences were reasons to initiate WW, followed by tumor-related factors in 55 percent. For 35 and 46 percent of the patients, respectively, treatment-related and circumstantial reasons were important. Overall, 47 percent of tumors increased in size. There was a correlation observed for tumor growth with BCC subtype (odds ratio, 3.5) but not with initial tumor size and location. The estimated tumor diameter increase in one year was 4.46 and 1.06 mm for BCCs containing at least an infiltrative/micronodular component and for the remaining BCCs (only nodular/superficial component/clinical diagnosis), respectively. Tumor burden or potential tumor burden, resolved reasons for WW, and reevaluation of patient-related factors were the most common reasons for initiating treatment.

"Patient preferences, treatment goals, and the option for proceeding with a WW approach should be discussed as part of personalized shared decision making," the authors write.

Two authors disclosed financial ties to the biopharmaceutical industry.

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