Radial Sectioning For Basal Cell Carcinoma: A Case Report

Background: Locally advanced basal cell carcinoma (laBCC) is a form of basal cell carcinoma that has spread deeper into surrounding tissues but has not metastasized to distant parts of the body.It is usually managed with hedgehog inhibitors (Hhi) when the tumour is considered not amenable for surgery or radiotherapy.However, during the treatment course with Hhi, the tumor might experience a partial response and might be surgically treated.Methods: We aimed to describe the use of the drug Sonidegib in a neoadjuvant regimen in real practice in Spain.Results: In this retrospective study we included 14 patients (7 males and 7 females) with 15 initially non-surgical laBCC (due to size or location), in which surgical treatment was performed after treatment with sonidegib.Mean age was 77,14 years (50-94).Most laBCC were localized in periocular area (10); other regions were perioral area (1), scalp (1), nasal (2) and neck (1).Histologically 13 tumors were infiltrative BCC and 2 morpheiform.The mean size was 25mm (5-57mm).8 tumors showed a mean decreased size of 30% (5%-57%); In 9 tumors a more aggressive surgery could be avoided.Mean time of treatment was 56 weeks (7-72 weeks, median 20 weeks).11 patients developed secondary effects, most commonly alopecia and muscle spasm.According to the results found in our study, more than half of the patients for whom treatment with sonidegib is proposed, could benefit in a second stage, due to the reduction of tumor size, from a surgical rescue.The use of sonidegib and vismodegib in reducing tumor size in patients with advanced BCC, allowing less radical surgeries and improving cosmetic and functional outcomes, has previously been highlighted.In some cases likelihood of curative resection increased.Conclusions: HHi have shown promising promising as neoadjuvant therapies in reducing tumor size and surgical defect areas in patients with advanced BCC.These treatments might facilitate less extensive surgeries and improve cosmetic and functional outcomes.Further studies with larger sample sizes and long-term follow-up are warranted to fully establish the benefits and risks of neoadjuvant hedgehog inhibitor therapy.