Guest: Dr. Vishal Patel

Basal cell carcinoma is often considered the “easy” skin cancer, managed with a straightforward excision and quickly forgotten. But not every BCC follows the script. In this episode of the JDD Podcast, host Dr. Adam Friedman sits down with cutaneous oncology expert Dr. Vishal Patel to explore the patients who challenge that assumption and why recognizing locally advanced basal cell carcinoma (laBCC) early can fundamentally change outcomes. Together, they unpack what truly defines laBCC beyond tumor size alone, discuss the clinical and patient factors that move a lesion outside the standard treatment algorithm, and examine when cutting can be…cut out. The conversation provides a practical review of Hedgehog pathway inhibition, including where sonidegib fits within the contemporary treatment landscape, key considerations for patient selection, counseling strategies that improve adherence, and practical approaches to managing treatment-related adverse events. Whether you routinely treat advanced skin cancer or simply want to better recognize when a “routine” basal cell carcinoma is anything but, this episode offers practical insights to help clinicians identify complex disease earlier, individualize treatment decisions, and rethink what success looks like for patients with locally advanced BCC.