Autopsy and Case Reports
https://autopsyandcasereports.org/article/doi/10.4322/acr.2019.116
Autopsy and Case Reports
Article / Clinical Case Report

Basal cell carcinoma: multimodal treatment and the role of neoadjuvant vismodegib

Pedro Carvalho Martins; Rita Valença Filipe; Rui Barbosa; Ivo Julião; Rosa Azevedo; Matilde Ribeiro; Abreu de Sousa

Downloads: 0
Views: 177

Abstract

Basal cell carcinoma (BCC) is the most common skin cancer. It generally has an indolent course with low rates of metastasis and mortality. However, BCC is locally invasive and can cause significant morbidity due to destructive local spread. We report our experience with a patient who was referred to our skin cancer unit due to a previously neglected lesion on the parietal region of the scalp, which had developed for 7 years. The patient was prescribed vismodegib on the basis that surgery could cause excessive functional and aesthetic damage. The patient had an objective partial response after 20 months of treatment. He was then submitted to radical skin excision, leaving a large defect that was reconstructed using a free latissimus dorsi muscle flap. The patient recovered well, and at the 1-year follow-up there were no signs of local recurrence.

Our case demonstrates the value of vismodegib treatment prior to surgery in a locally advanced, high-risk scalp BCC and highlights the importance of an individualized and specialized approach with these patients, within a multidisciplinary team.

Keywords

Carcinoma, Basal Cell, Interdisciplinary Research, Neoadjuvant Therapy, Reconstructive Surgical Procedures

References

Lomas A, Leonardi-Bee J, Bath-Hextall F. A systematic review of worldwide incidence of nonmelanoma skin cancer.

 

Br J Dermatol. 2012;166(5):1069-80. [https://doi.org/10.1111/j.1365-2133.2012.10830.x]. [PMID:22251204]
 

 

Trakatelli M, Morton C, Nagore E, et al. Update of the European guidelines for basal cell carcinoma management.

 

 

Eur J Dermatol. 2014;24(3):312-29. [https://doi.org/10.1684/ejd.2014.2271]. [PMID:24723647]
 

 

Bath-Hextall FJ, Perkins W, Bong J, Williams HC. Interventions for basal cell carcinoma of the skin.

 

 

Cochrane Database Syst Rev. 2007;(1):1-64. [https://doi.org/10.1002/14651858.CD003412.pub2]. [PMID:17253489]
 

 

Epstein EH. Basal cell carcinomas: attack of the hedgehog.

 

 

Nat Rev Cancer. 2008;8(10):743-54. [https://doi.org/10.1038/nrc2503]. [PMID:18813320]
 

 

Gailani MR, Bale AE. Developmental genes and cancer: role of patched in basal cell carcinoma of the skin.

 

 

J Natl Cancer Inst. 1997;89(15):1103-9. [https://doi.org/10.1093/jnci/89.15.1103]. [PMID:9262247]
 

 

Reifenberger J, Wolter M, Knobbe CB, et al. Somatic mutations in the PTCH, SMOH, SUFUH and TP53 genes in sporadic basal cell carcinomas.

 

 

Br J Dermatol. 2005;152(1):43-51. [https://doi.org/10.1111/j.1365-2133.2005.06353.x]. [PMID:15656799]
 

 

Von Hoff DD, LoRusso PM, Rudin CM, et al. Inhibition of the hedgehog pathway in advanced basal-cell carcinoma.

 

 

N Engl J Med. 2009;361(12):1164-72. [https://doi.org/10.1056/NEJMoa0905360]. [PMID:19726763]
 

 

Sekulic A, Migden MR, Oro AE, et al. Efficacy and safety of vismodegib in advanced basal-cell carcinoma.

 

 

N Engl J Med. 2012;366(23):2171-9. [https://doi.org/10.1056/NEJMoa1113713]. [PMID:22670903]
 

 

Sekulic A, Migden MR, Lewis K, et al. Pivotal ERIVANCE basal cell carcinoma (BCC) study: 12-month update of efficacy and safety of vismodegib in advanced BCC.

 

 

J Am Acad Dermatol. 2015;72(6):1021-6.
 

 

Ally MS, Aasi S, Wysong A, et al. An investigator-initiated open-label clinical trial of vismodegib as a neoadjuvant to surgery for high-risk basal cell carcinoma.

 

 

J Am Acad Dermatol. 2014;71(5):904-11.
 

 

Kwon GP, Ally MS, Bailey-Healy I, et al. Update to an open-label clinical trial of vismodegib as neoadjuvant before surgery for high-risk basal cell carcinoma (BCC).

 

 

J Am Acad Dermatol. 2016;75(1):213-5. [https://doi.org/10.1016/j.jaad.2016.02.1235]. [PMID:27317518]
 

 

Alcalay J, Tauber G, Fenig E, Hodak E. Vismodegib as a neoadjuvant treatment to Mohs surgery for aggressive basal cell carcinoma.

 

 

J Drugs Dermatol. 2015;14(3):219-23. [PMID:25738842]
 

 

Aldabagh B, Yu J, Perkocha LA, Arron S. Histologic changes in basal cell carcinoma after treatment with vismodegib.

 

 

Dermatol Surg. 2013;39(11):1703-5. [https://doi.org/10.1111/dsu.12281]. [PMID:23879864]
 

 

Chang AL, Atwood SX, Tartar DM, Oro AE. Surgical excision after neoadjuvant therapy with vismodegib for a locally advanced basal cell carcinoma and resistant basal carcinomas in Gorlin syndrome.

 

 

JAMA Dermatol. 2013;149(5):639-41. [https://doi.org/10.1001/jamadermatol.2013.30]. [PMID:23677114]
 

 

Kahana A, Worden FP, Elner VM. Vismodegib as eye-sparing adjuvant treatment for orbital basal cell carcinoma.

 

 

JAMA Ophthalmol. 2013;131(10):1364-6. [https://doi.org/10.1001/jamaophthalmol.2013.4430]. [PMID:23907144]
 

 

Sagiv O, Nagarajan P, Ferrarotto R, et al. Ocular preservation with neoadjuvant vismodegib in patients with locally advanced periocular basal cell carcinoma.

 

 

Br J Ophthalmol. 2018;103(6):775-80. [https://doi.org/10.1136/bjophthalmol-2018-312277]. [PMID:30021814]
 

 

Demirci H, Worden F, Nelson CC, Elner VM, Kahana A. Efficacy of vismodegib (Erivedge) for basal cell carcinoma involving the orbit and periocular area.

 

 

Ophthal Plast Reconstr Surg. 2015;31(6):463-6. [https://doi.org/10.1097/IOP.0000000000000388]. [PMID:25675162]
 

 

U.S. National Library of Medicine [Internet].

 

 

Neoadjuvant Vismodegib in Patients with Large and/or Recurrent Resectable Basal Cell Carcinoma. Bethesda: U.S. National Library of Medicine; 2017 [cited 2019 Jan 15]. Available from: https://ClinicalTrials.gov/show/NCT03035188.
 

 

ClinicalTrials.gov [Internet].

 

 

A study of Vismodegib with surgery in participants with previously untreated Basal Cell Carcinoma. Bethesda: U.S. National Library of Medicine; 2013 [cited 2019 Jan 15]. Available from: https://ClinicalTrials.gov/show/NCT01898598.
 

 

ClinicalTrials.gov [Internet].

 

 

Vismodegib in treating patients with Basal Cell Carcinoma (BCC). Bethesda: U.S. National Library of Medicine; 2012 [cited 2019 Jan 15]. Available from: https://ClinicalTrials.gov/show/NCT01631331.
 

 

ClinicalTrials.gov [Internet].

 

 

Vismodegib for treatment of Basal Cell Carcinoma. Bethesda: U.S. National Library of Medicine; 2012 [cited 2019 Jan 15]. Available from: https://ClinicalTrials.gov/show/NCT01543581.
 

 

ClinicalTrials.gov [Internet].

 

 

Study evaluating the interest of Vismodegib as neo-adjuvant treatment of basal cell carcinoma (BCC). Bethesda: U.S. National Library of Medicine; 2016 [cited 2019 Jan 15]. Available from: https://ClinicalTrials.gov/show/NCT02667574.
 

 

Mortier L, Bertrand N, Basset-Seguin N, et al. Vismodegib in neoadjuvant treatment of locally advanced basal cell carcinoma: First results of a multicenter, open-label, phase 2 trial (VISMONEO study).

 

 

Journal of Clinical Oncolog. 2018;36(15 Suppl):9509-9509
 

 

Basset-Seguin N, Hauschild A, Grob JJ, et al. vismodegib in patients with advanced basal cell carcinoma (STEVIE): a pre-planned interim analysis of an international, open-label trial.

 

 

Lancet Oncol. 2015;16(6):729-36. [https://doi.org/10.1016/S1470-2045(15)70198-1]. [PMID:25981813]
 

 

Rochlin DH, Broyles JM, Sacks JM. Scalp reconstruction with free latissimus dorsi muscle.

 

 

Eplasty. 2013;13:1-6. [PMID:23943680]
 

 

Lipa JE, Butler CE. Enhancing the outcome of free latissimus dorsi muscle flap reconstruction of scalp defects.

 

 

Head Neck. 2004;26(1):46-53. [https://doi.org/10.1002/hed.10338]. [PMID:14724906]
 

 

Zhong T, Gullane P, Neligan P. Bilateral latissimus dorsi flaps for the reconstruction of extensive scalp defects.

 

 

Can J Plast Surg. 2003;11(2):79-82. [https://doi.org/10.1177/229255030301100201]. [PMID:24222989]
 

 

Earley MJ, Green MF, Milling MA. A critical appraisal of the use of free flaps in primary reconstruction of combined scalp and calvarial cancer defects.

 

 

Br J Plast Surg. 1990;43(3):283-9. [https://doi.org/10.1016/0007-1226(90)90073-9]. [PMID:2350633]

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


Publication date:
09/27/2019

5d8e4cf50e8825fc5f140c97 autopsy Articles
Links & Downloads

Autops Case Rep

Share this page
Page Sections