Oral smoothened inhibitor for advanced basal cell carcinoma of the hand: a case report
A 43-year-old Caucasian man with a known history of genetic predisposition to BCC presented with multiple large ulcerated, biopsy proven BCCs on his head, trunk, arms, and legs []. In particular, he noted the inability to type on a keyboard, drive a car, or carry out activities of daily living due to the large BCCs studding his dorsal hands, including some that traversed the joints. He had a 2.5-cm multilobular BCC on the distal tip of the left small finger (Fig. ).\nAfter a discussion of his treatment options, the patient elected to begin therapy with oral vismodegib 150 mg daily, due to the size and extent of his tumors. After 1 month, shrinkage of all of the BCCs was apparent (Fig. ). After 6 months of treatment, the BCCs had regressed further, with the lesion on the distal fifth digit receding the slowest (Fig. ). Continued treatment led to further BCC shrinkage (Fig. ). Due to his vismodegib treatment, he regained the ability to carry out activities of daily living, with good functional and aesthetic results. While there are visible scars in areas of previous BCC, the patient reported no limitation in hand movement. In addition, several areas of erosion and erythema were persistent at 3 years and 4 months of follow-up, including the web space between the third and fourth digits, suggesting that a small amount of residual BCCs remained. However, the patient declined biopsy in the absence of lesion growth. He continues to be monitored with full body skin examinations every month for BCC chemoresistance.\nOver the course of treatment, the patient experienced commonly reported side effects, including hair loss and mild muscle cramping in the legs. He did not require treatment for his muscle cramping. Otherwise, the drug was well tolerated.