Vismodegib as Eye-Sparing Neoadjuvant Treatment for Locally Advanced Periocular Basal Cell Carcinoma

May 2021 | Volume 20 | Issue 5 | Case Reports | 552 | Copyright © May 2021


Published online April 28, 2021

Lauren Angnardo BSa, Yasmine Humeda BSa, Irene Alexandraki MD MPHb, Christopher M. Wolfe DOa, Armand B. Cognetta Jr. MDa

aDivision of Dermatology, Mohs Micrographic Surgery Unit, Florida State University College of Medicine, Tallahassee, FL
bDepartment of Clinical Sciences, Florida State University College of Medicine, Tallahassee, FL

Abstract
Locally-advanced periocular basal cell carcinoma (BCC) pose many therapeutic challenges due to the need to preserve functionality and cosmesis of the orbit and periocular area. Surgical excision and subsequent orbital exenteration are two recognized modalities of treatment. Vismodegib is currently an FDA-approved monotherapy for locally-advanced and metastatic BCC. We present a case of the use of vismodegib as neoadjuvant therapy prior to surgical excision of a locally-advanced periocular recurrent BCC in a 75-year-old male. The patient’s tumor successfully responded to vismodegib allowing surgical excision with clear margins. The orbit was saved in a patient who otherwise would have required complete orbital exenteration.

J Drugs Dermatol. 20(5):552-554. doi:10.36849/JDD.5661

INTRODUCTION

Locally-advanced basal cell carcinoma (BCC) often pose considerable therapeutic challenges because of the need to preserve functionality and cosmesis of the affected region.1 In high-risk, aggressive or recurrent tumors of the periocular space, orbital exenteration is a therapeutic option in order to lower rates of tumor recurrence.2 When a tumor involves the medial canthal area and histology demonstrates an infiltrative subtype, exenteration is strongly recommended.3 Vismodegib, a hedgehog signaling pathway inhibitor, is currently an FDA- approved monotherapy for locally-advanced and metastatic BCC.4 Recently, studies have begun to investigate the use of vismodegib as a neoadjuvant therapeutic approach prior to surgery for locally-advanced BCC. We present a case of the use of vismodegib as neoadjuvant therapy prior to surgical excision of a locally-advanced periocular recurrent BCC in a patient who otherwise would have required a complete orbital exenteration. We also review the current literature.

CASE REPORT

A 75-year-old male presented to the dermatology clinic with a draining ulcerated lesion of the right medial canthal area with exophthalmos and proptosis of the right eye for approximately eight months. The patient reported poor vision in his left eye that had been present for years and normal vision in his right eye. Relevant past medical history included surgical excision of BCC in his right medial canthus in 1992, and radiation for treatment of recurrent BCC in the same location in 2010. Physical examination revealed a draining ulcerated lesion in the right medial canthal area and exophthalmos and proptosis of the right eye (Figure 1). An MRI of the orbits and neck with and without contrast revealed a 14x9x19 millimeter enhancing mass medial to the medial rectus muscle (Figure 2). Biopsy of the mass revealed poorly differentiated infiltrative BCC.