Facilitators of and obstacles to consultation in patients with advanced basal cell carcinoma: a French pilot study

Arch Dermatol Res. 2021 Dec;313(10):829-835. doi: 10.1007/s00403-020-02175-x. Epub 2021 Jan 12.


Basal cell carcinoma is the most common skin cancer for which surgery is usually the unique and definitive treatment. Advanced basal cell carcinoma is not eligible to surgery when underlying structures are destroyed. Delayed consultation is the principal cause of advanced basal cell carcinoma. It is questionable why some patients seek care only when the tumour is advanced. The objective of this study was to identify the psychosocial factors involved in delayed consultation. We used a qualitative approach, conducting semi-structured interviews with advanced basal cell carcinoma patients and the healthcare staff of a dermatology unit to explore why some patients consult only when basal cell carcinoma is advanced. We then put our findings into perspective and created a logical model for change. We interviewed 14 patients and 12 healthcare staff. The first lesion was associated with banalization. Then, denial and fear of diagnosis or treatment were post common. Finally, the advanced basal cell carcinoma's symptoms, along with social pressure, created the intention to seek medical help and improved disease awareness. We developed a logical model that summarizes these findings. In this pilot study, we modelled factors that delayed consultation. This will aid future research and targeted interventions reducing delay, in particular by improving knowledge and by using social pressure as facilitators. Trial registration: NCT04124796.

Keywords: Advanced basal cell carcinoma; Delay in consultation; Perceptions; Psychosocial determinants; Symptoms and disease.

Publication types

  • Clinical Trial

MeSH terms

  • Aged
  • Aged, 80 and over
  • Carcinoma, Basal Cell / diagnosis*
  • Carcinoma, Basal Cell / pathology
  • Carcinoma, Basal Cell / psychology
  • Carcinoma, Basal Cell / surgery
  • Delayed Diagnosis / psychology*
  • Delayed Diagnosis / statistics & numerical data
  • Fear
  • Female
  • France
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Patient Acceptance of Health Care / psychology*
  • Patient Acceptance of Health Care / statistics & numerical data
  • Pilot Projects
  • Prospective Studies
  • Qualitative Research
  • Referral and Consultation / statistics & numerical data*
  • Skin Neoplasms / diagnosis*
  • Skin Neoplasms / pathology
  • Skin Neoplasms / psychology
  • Skin Neoplasms / surgery
  • Surveys and Questionnaires / statistics & numerical data
  • Time-to-Treatment / statistics & numerical data

Associated data

  • ClinicalTrials.gov/NCT04124796