case_images: PMC10937045_01
case_images: Pretreatment anatomic photographs of upper-back lesion. a Initial hospitalization (left). b First surgical oncology visit (right).
case_images: cde-2024-0016-0001-537817_F01.jpg
case_images: PMC10937045_01_cde-2024-0016-0001-537817_F01.jpg
case_images: F1
case_images: The patient was hospitalized 12 months prior for an episode of heart failure, when the lesion was first documented (Fig. 1a) and biopsy showed angulated nests of BCC in an infiltrative pattern. Unfortunately, the initial evaluation was missed, and he re-presented 12 months later, at which time the lesion had increased in size and measured 7 x 7 cm (Fig. 1b).
case_images: Anatomic photographs of upper-back lesion throughout hedgehog pathway inhibitor chemotherapy. a Three weeks (upper left). b 10 weeks (upper right). c 14 weeks (lower left). d 18 weeks (lower right).
case_images: cde-2024-0016-0001-537817_F02.jpg
case_images: PMC10937045_01_cde-2024-0016-0001-537817_F02.jpg
case_images: F2
case_images: He was seen in surgical oncology clinic after 3 weeks of treatment, when the lesion appeared similar in size diameter, but the lesion's central aspect seemed to have less necrosis (Fig. 2a). After 10 weeks of therapy, there was significant improvement in both the lesion appearance and diminishment in size (6 cm x 6 cm), and there no longer appeared to be any fixation to underlying muscle fascia (Fig. 2b). After 14 weeks of treatment, there remained two smaller nonhealing regions (larger 2.5 cm x 3 cm, smaller lesion 1 cm x 1 cm) (Fig. 2c). By 18 weeks of therapy, it appeared that the central aspect of the lesion had completely resolved, but there remained three small peripheral lesions (Fig. 2d).
case_images: Posttreatment anatomic photographs of upper-back lesion. a At time of discontinuation (left). b 14 weeks posttreatment (right).
case_images: cde-2024-0016-0001-537817_F03.jpg
case_images: PMC10937045_01_cde-2024-0016-0001-537817_F03.jpg
case_images: F3
case_images: At 26 weeks of therapy, only a single 7-mm nodular lesion remained (Fig. 3a) and vismodegib therapy was discontinued. Follow-up, 14 weeks after discontinuing therapy, in clinic (Fig. 3b) and subsequent surveillance visits at one and 2 years have demonstrated no evidence of local recurrence.