Complete remission of an advanced basal cell carcinoma after only 3‐month treatment with sonidegib: Report of a case and drug management during COVID‐19 pandemic

Dear Editor Advanced basal cell carcinoma (BCC) has always represented a challenge for dermatologists until the oral hedgehog inhibitor (HHI) drugs were approved. Approximately 80% of locally advanced (la) BCCs occur in the head and neck region impacting on patients' quality of life. Although surgery is the first-line therapy for BCC, some cases can progress to an advanced or rarely to a metastatic state, ineligible for nonsurgical approaches such as cryotherapy, adjuvant radiotherapy, and targeted therapy are required. Here, we report the case of a patient presenting with a laBCC of the nuchal region who had a brilliant response after only three-month treatment with sonidegib. The patient gave written informed consent for publication of his case details. A 67-year old man presented to our Department with an inoperable recurrent laBCC involving the left side of the nuchal region (Figure 1A). One year earlier, he was treated with complete surgery excision of the lesion that was histologically diagnosed as BCC, aggressive-type. The BCC recurred one year later presenting as a roundish ulcerated suppurative lesion, measuring 3 × 3 cm in diameter and 2 cm in depth. Itching and pain was reported. He had no comorbidities except for hypertension treated with beta-blockers. Laboratory analyses were within the normal limits, including creatinphosphokinase (CPK) (111 UI/L n.v.: <380 UI/L) level. Radiation therapy was not considered as an option because of cumulative dose limitations to critical structures. Given tumor dimension and the inability to treat it with surgery he was placed on sonidegib, an oral inhibitor of the Hedgehoh (Hh) pathway. The small drug was given at a dosage of 200 mg/daily. After only 3 months of treatment he presented a brilliant response with approximately >95% reduction in tumor size and a complete healing of the ulcer documented at clinical and dermoscopic examination (Figure 1B). In particular, dermoscopic examination showed the presence of fibrosis with residual keratin and irregular linear vessels crossing the scar. The patient received a monthly followup visit. Due to the Coronavirus disease (COVID)-19 emergency, the patient received a videoconsultation for the first follow-up visit, and blood exams results were sent by email, in order to avoid treatment discontinuation. No adverse events were reported and CPK values