The treatment of basal cell carcinoma (BCC) has remained largely unchanged for the past 50 years. Recently, the use of immunomodulators such as imiquimod have been used to treat early lesions. However, the treatment of inoperable BCC did not evolve significantly until the advent of vismodegib. This drug inhibits the hedgehog pathway, which is often defective in BCC, and the United States Food and Drug Administration has approved vismodegib to treat BCC that is locally advanced or metastatic. The use of this drug requires physicians to have an understanding of where it is and where it is not applicable, how the drug works, and which adverse events are associated with it. This supplement details one case of locally advanced BCC and provides information on the therapeutic decisions made for the patient detailed. In addition, information about the mechanisms of action for vismodegib and the burden of disease imposed by advanced or metastatic BCC are provided to help clinicians gain an understanding of the true burden of this disease.
Kenneth R. Beer MD FAADa and Michael S. Beer aPalm Beach Plastic Surgery Center West Palm Beach, FL
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