Treatment Of Basal Cell Carcinoma With Vismodegib: Future Or Present?

Background: Since the introduction of Vismodegib as treatment of recurrent locally advanced basal cell carcinoma (laBCC), clinicians are faced with new dilemmas: 'Can Vismodegib replace complex reconstructions?', 'What is the role of neoadjuvant use of Vismodegib?' and 'What is the best approach in case of complete clinical remission after Vismodegib in a neoadjuvant setting?' Methods: Case report and literature review. Results: Case report Complete dermoscopic remission after eight months Vismodegib was obtained in a patient with recurrent laBCC. Follow-up was 12 months. Literature review: Vismodegib shows histologic clearance in 42% of patients with operable basal cell carcinoma. Recurrence after neoadjuvant use of Vismodegib in laBCC was described. Moreover, histology revealed residual tumour cells in cases of complete clinical remission after 6 months Vismodegib. Conclusions: Vismodegib cannot replace complex reconstructions. However, in unresectable laBCC, Vismodegib can provide a bridge to surgery. Due to the possibility of persistent tumour cells, we recommend imaging-assisted surgery and an imaging-based follow-up. In case of complete clinical remission after Vismodegib in a neoadjuvant setting, we recommend that Vismodegib be continued as long as the adverse effects are tolerated and an imaging-based follow-up is advised.