Headline about basal cell carcinoma was misleading

Editor—The headline “Basal cell carcinoma should be excised” given in This week in the BMJ for the systematic review by Bath-Extall et al of interventions for basal cell carcinoma of the skin was a misleading misrepresentation of the conclusions.¹ The authors conclude that inadequate research is available on the choice of treatment for basal cell carcinoma but that on this limited evidence surgery and radiotherapy seem to be the most effective treatments.

The authors emphasise the lack of evidence for different treatments, not evidence of lack of efficacy. Most effective is not equivalent to most appropriate. Basal cell carcinomas are a very heterogeneous group of tumours, and factors such as tumour site, general health, and particularly patients' preferences are important in determining optimum treatment in each individual case. To state that basal cell carcinoma should be excised is an oversimplification and likely to mislead readers.