Efficacy and Safety of Sonidegib Combined with Photodynamic Therapy in Basal Cell Carcinoma: A Retrospective Case Series of 7 Patients

BACKGROUND: Management of basal cell carcinoma (BCC) in cosmetically critical facial areas remains challenging when surgery is contraindicated or declined. Although Hedgehog pathway inhibitors (HHIs) and photodynamic therapy (PDT) are established non-surgical options, monotherapies have limitations. Combining systemic targeted therapy with local treatment may improve outcomes. OBJECTIVE: To evaluate the efficacy and safety of short-course oral Sonidegib combined with fractional CO₂ laser-assisted 5-aminolevulinic acid photodynamic therapy (ALA-PDT) for treating facial BCC unsuitable for surgery. METHODS: This retrospective case series involved 7 consecutive patients with histologically confirmed facial BCC unsuitable for or declined surgery. Patients received oral Sonidegib (200 mg daily for 6 weeks) combined with six sessions of ALA-PDT preceded by ablative fractional CO₂ laser pretreatment. Clinical responses were assessed at 1, 3, and 6 months using modified WHO criteria. RESULTS: All patients completed treatment. Complete response (CR) rates were 71.4% (5/7) at 1 month and 100% (7/7) at 3 and 6 months, with no recurrences. No typical systemic adverse events associated with long-term Sonidegib (e.g., muscle spasms, dysgeusia) occurred. PDT-related reactions were mild and transient, with no scarring or pigmentary changes. CONCLUSION: Short-course Sonidegib combined with fractional CO₂ laser-assisted ALA-PDT demonstrates high efficacy and favorable tolerability for facial BCC unsuitable for surgery, offering a durable non-surgical alternative warranting prospective validation.