Beyond clear margins: What matters to patients with basal cell carcinoma?

Abstract

A common assumption in the management of basal cell carcinoma (BCC), is that tumour clearance trumps all other concerns from the patient’s perspective. Histological clearance is often a key performance indicator, while regard for form and function, the founding principle of our specialty, may go unexamined. Frequently audits – whether local, regional or national - focus on histological clearance rates, without regard for other outcomes, beyond infection or readmission.1 This is at odds with a trend toward greater emphasis on patient-related outcome measures (PROMs), and shared decision making. The corollary of the adage “you can’t improve what you don’t measure”, is that if only one metric is considered, it may be the only that ‘improves’ at the expense of others. A singular emphasis on histological clearance may inculcate a culture of overtreatment and over-excision amongst surgeons of all levels.