A 73-year-old female presented to clinic with a large ulcerated lesion involving the forehead, glabella, upper eyelids and extending towards the medial canthi bilaterally. The lesion had been present and growing for over 19 years, but the patient was reluctant to seek medical care. Incisional biopsy of the lesion confirmed nodular basal cell carcinoma, and CT imaging found no evidence of bony destruction. Given the large extent of the lesion the patient was started on the oral Hedgehog pathway inhibitor vismodegib with plan for subsequent radiotherapy or surgical resection. After 10 weeks of therapy the ulcerated lesion had been replaced by granulation tissue, and the patient was deemed to have achieved a complete clinical response. Resistance to hedgehog inhibitors is common and limits response duration. The patient will undergo radiotherapy for definitive treatment.
Presentation Date: 10/03/2019
Issue Date: 08/01/2020