Comparative Analysis of US Guidelines for the Management of Cutaneous Squamous Cell and Basal Cell Carcinoma

Table 2

Quality of evidence.

AAD		ASTRO
Grade	Definition	Grade	Definition
I	Good-quality patient-oriented evidence (i.e., evidence-measuring outcomes that matter to patients: morbidity, mortality, symptom improvement, cost reduction, and quality of life)	High	(i) 2 or more well-conducted and highly generalizable RCTs or meta-analyses of such trials
II	Limited-quality patient-oriented evidence	Moderate	(i) 1 well-conducted and highly generalizable RCT or a meta-analysis of such trials OR
			(ii) 2 or more RCTs with some weaknesses of procedure or generalizability OR
			(iii) 2 or more strong observational studies with consistent findings
III	Other evidence, including consensus guidelines, opinion, case studies, or disease-oriented evidence (i.e., evidence measuring intermediate, physiologic, or surrogate end points that may or may not reflect improvements in patient outcomes)	Low	(i) 1 RCT with some weaknesses of procedure or generalizability OR
			(ii) 1 or more RCTs with serious deficiencies of procedure or generalizability or extremely small sample sizes OR
			(iii) 2 or more observational studies with inconsistent findings, small sample sizes, or other problems that potentially confound interpretation of data
Expert opinion		Expert opinion
Strength of recommendation
AAD		ASTRO
Ranking	Definition	Strength	Definition
A	Recommendation based on consistent and good-quality patient-oriented evidence	Strong	(i) Benefits clearly outweigh risks and burden, or risks and burden clearly outweigh benefits
			(ii) All or almost all informed people would make the recommended choice
B	Recommendation based on inconsistent or limited-quality patient-oriented evidence	Conditional	(i) Benefits are finely balanced with risks and burden or appreciable uncertainty exists about the magnitude of benefits and risks
C	Recommendation based on consensus, opinion, case studies, or disease-oriented evidence		(ii) Most informed people would choose the recommended course of action, but a substantial number would not
			(iii) A shared decision-making approach regarding patient values and preferences is particularly important
NCCN guidelines version 2.2022
NCCN categories of evidence and consensus
Category 1	Based upon high-level evidence, there is uniform NCCN consensus that the intervention is appropriate
Category 2A	Based upon lower-level evidence, there is uniform NCCN consensus that the intervention is appropriate
Category 2B	Based upon lower-level evidence, there is NCCN consensus that the intervention is appropriate
Category 3	Based upon any level of evidence, there is major NCCN disagreement that the intervention is appropriate

(Adapted from References [9–11]). AAD = American Association of Dermatology, ASTRO = American Society of Radiation Oncology, RCT = randomized controlled trial, and expert opinion of panel members used due to the absence of or limitation in published evidence-based data.