INTRODUCTION: Basal cell carcinoma (BCC) is a cancer that arises from the basal layer of the epidermis and is most often caused by exposure to UV radiation. Most BCCs are localized and can be fully treated by surgical removal or topical treatment. In the last decade, it has been found that the hedgehog pathway, a signaling pathway that regulates embryonic development, has a pivotal role in the pathogenesis of BCC in adults. Therefore, two drugs that inhibit the hedgehog pathway have been developed. These drugs, indicated for metastatic or locally advanced BCC, may cause a rapid clinical and imaging response, but have an adverse reaction that includes muscle spasms, alopecia, dysgeusia and fatigue, and often leads to drug discontinuation. Due to the high rates of treatment discontinuation, the possibility of administering the drug intermittently was examined and, indeed, a decrease in adverse reactions together with tumor response was observed. Additionally, it seems that patients who discontinue treatment may benefit from long-term remission. These cases indicate the possibility of changing the schedule of administration of the drug. We hereby report two cases of patients who were treated with radiation therapy for ringworm in their childhood and developed BCC. The patients were treated with a hedgehog pathway inhibitor with complete tumor regression. After treatment was discontinued due to adverse reactions, no recurrence of the tumor was observed over a period of almost two years.
[prolonged Complete Remission after a Short Course of Hedgehog Pathway Inhibitors in Patients with Advanced Basal Cell Carcinoma: an Alternative to Surgery?]