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Case Reports
. 2018 Jul 31:11:177-179.
doi: 10.2147/IMCRJ.S168666. eCollection 2018.

Vismodegib and orbital excision for treating locally advanced basal cell carcinoma

Daniel T Hogarty  1 , Nicholas G Dewhurst  1 , Benjamin Burt  1   2   3   4
Affiliations
Case Reports

Vismodegib and orbital excision for treating locally advanced basal cell carcinoma

Daniel T Hogarty et al. Int Med Case Rep J. .

Abstract

Purpose: Orbital invasion of periocular basal cell carcinoma (BCC) is a potentially life-threatening condition with high levels of ocular morbidity. Exenteration results in significant disfigurement and permanent loss of vision. We report our experience with a patient who presented with medial orbit invasion of a BCC following 2 previous microscopically adequate local excisions of medial canthal BCC, an adequate Moh's micrographic surgical excision of the tumor, and radiotherapy. The patient underwent an orbital excision where the tumor was found to have perineural involvement and extend beyond the posterior margin. Following the pathology results of this procedure, the patient opted to try vismodegib (Erivedge®) to delay exenteration for as long as possible.

Observations: A course of vismodegib was taken by the patient with minor side effects (partial alopecia, mild dysgeusia and hyposmia, and minor muscle cramps). Subsequent imaging demonstrated no recurrence of the orbital tumor 29 months after orbital excision.

Conclusion and importance: We demonstrate the use of vismodegib with local orbital excision as an eye-saving alternative to exenteration for advanced orbital metastasis of BCC.

Keywords: basal cell carcinoma; hedgehog pathway inhibitor; locally advanced basal cell carcinoma; perineural; vismodegib.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
MRI before and after vismodegib and orbital excision. Notes: Imaging of orbital BCC (A) MRI demonstrating invasive BCC of the left orbit before excision and vismodegib. (B) MRI 22 months later demonstrating no evidence of recurrence; arrow points to tumor site on both images. MRI scans taken on different machines where no exact alignment of planes could be found on pre- and postoperative scans. Abbreviations: BCC, basal cell carcinoma; MRI, magnetic resonance imaging.
See this image and copyright information in PMC

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