Treatment of basal cell carcinoma in Scandinavia: evidence or eminence based?

BACKGROUND: Basal cell carcinoma (BCC) is a locally destructive form of skin cancer, mainly affecting Caucasians. There are multiple treatment options for BCC, with excisional surgery being most widely used. Choice of treatment may be dependent on clinical guidelines, local therapeutic traditions, and/or personal experience. Sweden is the only Scandinavian country with treatment guidelines for BCC.

METHODS: Eighty-six dermatologists from Sweden, Denmark, and Norway that were attending a meeting on photodynamic therapy were presented case history and clinical photographs of nine different BCCs and asked to select their treatment of choice among multiple options by the use of an electronic audience response system.

RESULTS: Treatment of choice differed substantially between dermatologists from the three countries. Swedish dermatologists more often chose excisional surgery (median 50%, range 0-90%) than their Danish (median 19%, range 0-44%) and Norwegian (median 35%, range 0-65%) colleagues. Very few Swedish dermatologists chose radiation therapy in the four cases where this was an option. Photodynamic therapy was more often selected by Norwegian dermatologists compared to Swedish and Danish dermatologists.

CONCLUSIONS: The treatment choices of Swedish dermatologists in cases of BCC are generally in line with Swedish treatment guidelines. National treatment guidelines for BCC should be established in all countries, including Denmark and Norway.