Vismodegib as Eye-Sparing Neoadjuvant Treatment for Locally Advanced Periocular Basal Cell Carcinoma

Area of Science:

• Ophthalmology
• Dermatology
• Oncology

Background:

• Locally-advanced periocular basal cell carcinoma (BCC) presents significant therapeutic challenges, balancing oncologic control with functional and cosmetic preservation of the orbit.
• Standard treatments include surgical excision and, in severe cases, orbital exenteration, which has profound functional and aesthetic consequences.

Observation:

• A case report details the treatment of a 75-year-old male with a recurrent, locally-advanced periocular BCC.

Findings:

• Vismodegib, an FDA-approved hedgehog pathway inhibitor, was administered as neoadjuvant therapy prior to surgical excision.
• The patient's BCC demonstrated a successful response to vismodegib, facilitating tumor removal with clear surgical margins.
• Crucially, the orbital exenteration, which was the likely alternative, was avoided, preserving the patient's orbit.

Implications:

• Neoadjuvant vismodegib represents a viable strategy for managing locally-advanced periocular BCC, potentially improving surgical outcomes.
• This approach offers a less invasive alternative to orbital exenteration, preserving ocular function and cosmesis.
• Further investigation into vismodegib's role in neoadjuvant settings for periocular BCC is warranted.