O. Charlton1, K. Phan2, S. Smith1, 3, 4
We present a 55-year-old female who recently received 12 months of sonidegib 200mg daily for recurrent facial basal cell carcinomas (BCCs) secondary to radiation therapy received as a teenager for acne in 1980. She was noted to have started developing facial BCCs by the age of 30, and at her initial consultation 12 months ago reported having had in excess of 20 facial lesions, all of which were managed surgically. Over the same time period, she had only a single BCC in a non-facial site. The patient was concerned about the long-term cosmetic impact of ongoing future surgeries. At her consultation 12 months prior, she was diagnosed with 11 new facial BCCs and elected to trial sonidegib 200mg daily, which was facilitated through compassionate access. She had no adverse events while on this therapy.
After 12 months, 4 of the 11 lesions had resolved clinically, 2 histologically, and the remaining 5 were markedly smaller, and managed with curettage and cautery. No new lesions developed during this period. In small studies, hedgehog inhibitors have been demonstrated to be effective in the management of radiation induced BCCs occurring in the radiotherapy treatment fields of previously treated non-melanoma skin cancer. However, this is the first reported case for the use of hedgehog inhibitors in this unique set of patients who have iatrogenic induced susceptibility to the development of BCCs.