Refractory Morpheaform Basal Cell Carcinoma Successfully Treated with Oral Sonidegib

Morpheaform basal cell carcinoma (BCC) is a high-risk histologic subtype accounting for approximately 5-10% of all basal cell carcinoma cases. We report a case of facial morpheaform BCC successfully treated with oral sonidegib in a patient for whom surgery was contraindicated because of severe thrombocytopenia. A 68-year-old woman presented with an indurated sclerotic plaque with papules and crusts on the left cheek. Histopathological examination confirmed the diagnosis of morpheaform BCC. Because of the high bleeding risk associated with thrombocytopenia, surgical treatment was not considered feasible. The patient was treated with oral sonidegib at a dose of 200 mg daily, resulting in progressive regression of the lesion. After approximately two years of therapy, near-complete clinical remission was achieved, and follow-up histopathological examination with five-point sampling showed no residual tumor. This case highlights the potential role of Hedgehog pathway inhibition as an effective tissue-sparing therapeutic option for patients with difficult-to-treat morpheaform BCC.