Current Use of Neoadjuvant Hedgehog Inhibitors Among Mohs Surgeons: Results of a Cross-Sectional Survey

Recent studies have demonstrated functional and cosmetic benefits with the use of hedgehog pathway inhibitors in the neoadjuvant setting for basal cell carcinoma (BCC). This study investigated the current use of neoadjuvant therapy by Mohs surgeons for the treatment of BCC with an anonymous REDcap survey distributed to members of the American College of Mohs Surgery. In the study population, a considerable percentage (22%) of Mohs surgeons reported current use of neoadjuvant hedgehog inhibitors for BCC prior to Mohs surgery. Among this group, there is wide variation in BCC size, location, target tumor size reduction, and average length of therapy for their use of neoadjuvant hedgehog inhibitors prior to Mohs surgery. Concerns about adverse effects and creating a discontinuous tumor were the most cited reasons not to treat patients with neoadjuvant hedgehog inhibitors prior to Mohs surgery. Given there is better tolerability of hedgehog pathway inhibitors when used for shorter treatment duration, hedgehog pathway inhibitors may be most useful in the neoadjuvant setting to maximize clinical benefit and minimize toxicity.