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ORIGINAL ARTICLE, p 739

Which treatment for skin cancer is the best? Developing guidelines, and studying effectiveness and cost‐effectiveness, is the business of dermatologists today. Patients’ preferences are highly appreciated, and both the patient's and doctor's experience can drive the choice of treatment. There are many other unintentional or unrecognized factors that may also influence this choice. For those who did not read Ben Goldacre's Bad Pharma, the wintertime may be well spent in its company.1

The study of Roozenboom et al.2 in this issue of the BJD is an example of well‐designed research, funded by the Netherlands Organization for Scientific Research. The study compares imiquimod with methyl aminolaevulinate photodynamic therapy (MAL‐PDT) in the treatment of superficial basal cell carcinomas. It is a clinically relevant subanalysis of an earlier paper by Arits et al.,3 in which 911 patients were assessed for eligibility. Of these patients 310 refused to participate, so 601 patients were included. The question remains: why did these 310 patients not want to participate? Still, the number of analysed patients is substantial and delivers relevant knowledge of the treatment choice to be made by patients and physicians. Refusal to participate may be due to patients’ preferences. Are experienced patients who have undergone painful PDT more likely to refuse? Are patients with busy lives unlikely to want to spend time in hospital? People in positions of responsibility may want the recuperation time to be as short as possible. Missing information about these 310 patients could greatly influence the results.

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