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Calik J, Oślizło M, Słocka-Romaniuk B, Elsaftawy A, Sauer N. Case report: Sequential treatment strategy for advanced basal cell carcinoma in Gorlin-Goltz syndrome: integration of vismodegib, radiotherapy, surgery, and high-intensity focused ultrasound. Front Oncol 2024; 14:1428702. [PMID: 39091908 PMCID: PMC11291366 DOI: 10.3389/fonc.2024.1428702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 07/01/2024] [Indexed: 08/04/2024] Open
Abstract
Managing advanced basal cell carcinoma (BCC) in patients with Gorlin-Goltz syndrome presents unique clinical challenges due to the tumor's aggressive nature and potential for widespread metastasis. This case study details a sequential treatment regimen for a 68-year-old female patient with an extensive, inoperable BCC. Employing a multimodal approach that integrates radiotherapy, the Hedgehog pathway inhibitor vismodegib, and High-Intensity Focused Ultrasound (HIFU), we demonstrate the potential for nearly complete remission in a patient with advanced BCC. Initial treatment with radiotherapy and vismodegib reduced tumor size significantly, but the largest mass displayed resistance over time, signifying the need for innovative therapies. Subsequent HIFU treatment targeted individual lesions, showcasing a non-invasive method that provided precise treatment while mitigating systemic side effects. The case emphasizes the necessity of continual adaptation in treatment plans to address the development of resistance and underscores the importance of incorporating new technologies and targeted therapies for complex BCC cases. The successful outcome of this integrated strategy suggests a promising direction for future research and highlights the importance of multidisciplinary approaches that tailor treatment to individual patient needs, tumor characteristics, and evolving therapeutic landscapes.
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Affiliation(s)
- Jacek Calik
- Department of Clinical Oncology, Wroclaw Medical University, Wrocław, Poland
- Old Town Clinic, Wrocław, Poland
| | | | - Beata Słocka-Romaniuk
- Department of Radiotherapy, Lower Silesian Center of Pulmonology, Oncology and Hematology in Wrocław, Wrocław, Poland
| | - Ahmed Elsaftawy
- Department of Plastic and Hand Surgery, St. Jadwiga Śląska Hospital, Trzebnica, Poland
| | - Natalia Sauer
- Old Town Clinic, Wrocław, Poland
- Department of Clinical Pharmacology, Faculty of Pharmacy, Wroclaw Medical University, Wrocław, Poland
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Murgia G, Valtellini L, Denaro N, Nazzaro G, Bortoluzzi P, Benzecry V, Passoni E, Marzano AV. Gorlin Syndrome-Associated Basal Cell Carcinomas Treated with Vismodegib or Sonidegib: A Retrospective Study. Cancers (Basel) 2024; 16:2166. [PMID: 38927872 PMCID: PMC11201977 DOI: 10.3390/cancers16122166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 06/03/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024] Open
Abstract
Nevoid basal cell carcinoma syndrome (NBCCS), also known as Gorlin syndrome (GS), is a genetic disorder characterized by the development of multiple cutaneous BCCs due to mutations in the hedgehog signaling pathway. The use of hedgehog pathway inhibitors-vismodegib and sonidegib-has emerged as a promising therapeutic strategy for managing BCCs in individuals with GS. In a retrospective study conducted between March 2012 and January 2024, a cohort of 16 Gorlin syndrome patients who received treatment with either sonidegib or vismodegib were analyzed. The primary objectives of the study were to evaluate the efficacy, safety profile, and duration of response to oral hedgehog inhibitors in this patient population. The study assessed various parameters, including the number of new BCCs that developed before and after treatment initiation, the duration and sustainability of treatment responses, as well as the incidence of adverse effects associated with hedgehog inhibitor therapy. The findings of the study revealed that sustained treatment with hedgehog inhibitors could effectively suppress the progression of both new and existing BCCs. Furthermore, the results indicated that sonidegib exhibited superior efficacy and safety compared to vismodegib in the treatment of BCCs in individuals with GS. Notably, adjustments to the administration schedule of sonidegib were found to improve tolerability without compromising therapeutic efficacy, potentially leading to prolonged durations of treatment response and disease control.
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Affiliation(s)
- Giulia Murgia
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy (P.B.); (V.B.); (E.P.); (A.V.M.)
| | - Luca Valtellini
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy (P.B.); (V.B.); (E.P.); (A.V.M.)
| | - Nerina Denaro
- Oncology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Gianluca Nazzaro
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy (P.B.); (V.B.); (E.P.); (A.V.M.)
| | - Paolo Bortoluzzi
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy (P.B.); (V.B.); (E.P.); (A.V.M.)
| | - Valentina Benzecry
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy (P.B.); (V.B.); (E.P.); (A.V.M.)
| | - Emanuela Passoni
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy (P.B.); (V.B.); (E.P.); (A.V.M.)
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy (P.B.); (V.B.); (E.P.); (A.V.M.)
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, 20133 Milan, Italy
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Bengoa-González A, Mencía-Gutiérrez E, Garrido M, Salvador E, Lago-Llinás MD. Advanced Periocular Basal Cell Carcinoma with Orbital Invasion: Update on Management and Treatment Advances. J Ophthalmol 2024; 2024:4347707. [PMID: 38456099 PMCID: PMC10919982 DOI: 10.1155/2024/4347707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 02/04/2024] [Accepted: 02/21/2024] [Indexed: 03/09/2024] Open
Abstract
Purpose Basal cell carcinoma (BCC) is the most frequent malignant periocular tumor. It is associated with exposure to ultraviolet radiation, and its incidence is gradually increasing. It may occasionally display more aggressive behavior and result in orbital or intracranial invasion. Mortality from periocular BBC with orbital invasion is very low, but the associated morbidity can be significant, from disfigurement to blindness. Traditionally, these cases have been treated with orbital exenteration or with radiotherapy (RT), but in recent years, hedgehog pathway inhibitors (HPIs) have emerged, are effective in more serious cases, and are used primarily or combined with surgery, changing our perspective on the management of these patients. Methods We studied 24 cases of periocular BCC with orbital invasion, some primary and others recurrent, which were treated between 2011 and 2021 in the same hospital. All patients had clinical or radiological evidence of orbital invasion. Orbital exenteration was performed on 9/24 of the patients (1 received vismodegib after surgery), and 12/24 were treated, surgically preserving the eyeball, with 3 of them receiving adjuvant vismodegib. Three of the twenty-four patients were treated exclusively with vismodegib (Erivedge®, Genentech). Results One patient died due to poor tumor evolution, but the rest evolved favorably and they have had no recurrences. Vismodegib was generally well tolerated, except for in one patient who discontinued treatment due to the side effects. Conclusions In advanced BBC with orbital invasion, mutilating surgical treatments such as exenteration or potentially vision-threatening treatments such as RT remain as options. In recent years, however, very promising new medical therapies have emerged, such as HPI, which can be used effectively instead of surgery or in combination with it, preserving the eye and vision, which implies a new approach to treatment.
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Affiliation(s)
| | | | - María Garrido
- Pathology Department, 12 de Octubre Hospital, Complutense University, Madrid, Spain
| | - Elena Salvador
- Radiology Department, 12 de Octubre Hospital, Complutense University, Madrid, Spain
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Gąsiorowski K, Gontarz M, Marecik T, Szczurowski P, Bargiel J, Zapała J, Wyszyńska-Pawelec G. Risk Factors for Orbital Invasion in Malignant Eyelid Tumors, Is Orbital Exenteration Still Necessary? J Clin Med 2024; 13:726. [PMID: 38337420 PMCID: PMC10856173 DOI: 10.3390/jcm13030726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/13/2024] [Accepted: 01/19/2024] [Indexed: 02/12/2024] Open
Abstract
Basal cell carcinoma is the most common malignant skin tumor of the eyelids in Caucasians, followed by squamous cell carcinoma and sebaceous gland carcinoma. The primary treatment for these tumors is radical excision. In cases where malignant eyelid tumors are advanced and have invaded the orbit, orbital exenteration is necessary. In this retrospective study, we aimed to determine the correlation between the risk of orbital infiltration and various factors like tumor location, size, histological type, and patient age. This study revealed that tumors in multiple regions increased the risk of orbital infiltration by 3.75 times. Tumors with a diameter of 21-30 mm raised the likelihood of requiring exenteration by 15.5 times compared to smaller tumors (up to 10 mm). Age was also associated with the likelihood of orbital invasion in periocular tumors. Interestingly, no correlation was found between the histological type of the tumor and the risk of orbital infiltration. Notably, the conjunctiva of the eyeball was the most commonly infiltrated orbital structure, followed by the orbital fat. Timely treatment and well-planned procedures are crucial for patients with malignant periocular skin tumors to avoid multiple reoperations and the potential need for orbital exenteration.
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Affiliation(s)
- Krzysztof Gąsiorowski
- Department of Cranio-Maxillofacial Surgery, Jagiellonian University Medical College, 30-688 Cracow, Poland; (M.G.); (T.M.); (P.S.); (J.B.); (J.Z.); (G.W.-P.)
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Khalil AA, Enezei HH, Aldelaimi TN, Mohammed KA. Advances in Diagnosis and Treatment of Basal Cell Carcinoma. J Craniofac Surg 2024:00001665-990000000-01294. [PMID: 38252534 DOI: 10.1097/scs.0000000000009959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 11/27/2023] [Indexed: 01/24/2024] Open
Abstract
Basal cell carcinoma (BCC) is one among the most prevalent malignant neoplasms that has exhibited a notable surge in global incidence over recent decades. This slow-growing malignancy is typified by its localized invasiveness while demonstrating an exceedingly rare metastatic proclivity. It predominantly afflicts the sun-exposed skin of aging individuals, with a heightened predilection for the maxillofacial region. Scraping cytology offers numerous benefits, including the potential for an earlier diagnosis and the absence of scarring, as opposed to a biopsy. The cytodiagnosis of BCC proves to be straightforward with various techniques, making it highly advantageous in an outpatient environment as a swift diagnostic method when planning a surgical excision. Our study sought to scrutinize the clinicopathological facets of BCC within the maxillofacial region. We compared advanced cytological techniques for diagnosis, including scraping, scratching, and imprinting using Papanicolau and Diff-Quick stains. In addition, we evaluated the therapeutic effectiveness of diode lasers operating at wavelengths of 940nm and 980n. A retrospective analysis was undertaken, encompassing facial BCC lesions smaller than 2.5 cm in diameter that underwent treatment through diode laser ablation between September 2021 and August 2023 at Ramadi Teaching Hospital and a private clinic in Ramadi City, Iraq. Among the cohort of 48 patients with BCC, a majority (58%) were 50 years of age or older, with a predominance of males (62%). The mean duration of lesion existence exceeded 4 months. The anatomical region most commonly involved was the middle 1/3 of the face, accounting for 34% of cases. Intriguingly, the therapeutic approach of diode laser ablation yielded exceptional esthetic and functional outcomes, which were consistently observed throughout the follow-up period post-healing. The occurrence of complications following diode laser ablation was relatively infrequent. This investigation revealed that cytological examination is easily conducted, eliminating the need for local anesthesia, saving time, being more cost-effective than a conventional biopsy, and delivering swift diagnoses. The process of smear-taking for cytology is well-tolerated, inflicting minimal trauma or discomfort on the patient. BCC predominantly afflicts elderly males and most frequently affects the middle third of the face. Notably, nodular BCC emerged as the prevailing histological subtype. The use of diode laser ablation exhibited a commendable track record, producing exemplary functional and esthetic outcomes over a 6-month follow-up period.
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Affiliation(s)
- Afrah A Khalil
- Department of Oral Diagnosis, Oral and Maxillofacial Pathologist, College of Dentistry, University of Anbar
| | - Hamid H Enezei
- Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Anbar, Anbar Province, Iraq
| | - Tahrir N Aldelaimi
- Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Anbar, Anbar Province, Iraq
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Wescott R, Samlowski W. Sustained Suppression of Gorlin Syndrome-Associated Basal Cell Carcinomas with Vismodegib or Sonidegib: A Case Series. Curr Oncol 2023; 30:9156-9167. [PMID: 37887561 PMCID: PMC10604938 DOI: 10.3390/curroncol30100661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 10/07/2023] [Accepted: 10/10/2023] [Indexed: 10/28/2023] Open
Abstract
Nevoid basal-cell carcinoma syndrome (Gorlin syndrome) is characterized by numerous cutaneous basal cell carcinomas mediated by mutations in the hedgehog pathway. Vismodegib or sonidegib represent promising treatment options. We identified 10 Gorlin patients who were treated with sonidegib (n = 6) or vismodegib (n = 4) between March 2012 and March 2022. We analyzed the activity, toxicity, and duration of the response to oral hedgehog inhibitors. The number of new tumors that developed prior to treatment or after treatment as well as the time of response and durability of responses were assessed. All patients achieved a complete remission. With a 30.7 ± 48.4-month median follow-up, the drug treatment significantly reduced the number of new basal cell cancers from a mean of 28.3 ± 24.6 prior to treatment to a mean of 1.4 ± 2.0 during treatment (p = 0.0048). The median time to develop a new basal cell cancer was 47.3 months. Three patients eventually developed localized recurrences. After resection, ongoing treatment suppressed the development of additional lesions. One patient developed numerous new drug-resistant basal cell cancers and died of acute leukemia. Six patients required treatment modifications for toxicity. Sustained hedgehog inhibitor treatment can suppress the progression of both new and existing basal cell carcinomas for an extended period. Drug administration schedule adjustments improved tolerance without altering efficacy, potentially contributing to a prolonged response duration.
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Affiliation(s)
- Raquel Wescott
- School of Medicine, University of Nevada, Reno, NV 89557, USA;
| | - Wolfram Samlowski
- School of Medicine, University of Nevada, Reno, NV 89557, USA;
- Comprehensive Cancer Centers of Nevada (Medical Oncology), Las Vegas, NV 89148, USA
- Department of Medicine, Kirk Kirkorian School of Medicine, University of Nevada Las Vegas (UNLV), Las Vegas, NV 89106, USA
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Villani A, Scalvenzi M, Micali G, Martora F, Cillo F, Raia F, Potestio L. An update on the current and emerging pharmacotherapies for basal cell carcinomas. Expert Opin Pharmacother 2023; 24:2143-2151. [PMID: 37963910 DOI: 10.1080/14656566.2023.2284351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 11/13/2023] [Indexed: 11/16/2023]
Abstract
INTRODUCTION Despite surgical approach is still the mainstay for basal cell carcinoma (BCC) management, several issues may limit the use of this technique, leading to the need for new treatments to offer patients a personalized approach. AREAS COVERED A comprehensive review of the available and emerging pharmacologic strategies for BCC management, including mechanisms of action, and potential adverse effects, has been performed to provide with an up-to-date manuscript on the current treatment scenario of BCC. Globally, targeting the Sonic-Hedgehog pathway is one of the main mechanisms of action of currently investigated drugs. Other alternatives are based on the concept of an enhancement of the immune response such as immune checkpoint inhibitors, or intra-tumor treatments. EXPERT OPINION Although low-risk BCCs are often treated with destructive methods or topical treatments, surgery is the mainstay of treatment for the majority of BCCs. However, several factors may limit the use of surgery in BCC management. Recently, major knowledge on BCCs pathogenesis has led to the development of effective and selective drugs. In our opinion, soon many drugs will be licensed, allowing clinicians to offer patients with BCC the right treatment at the right moment. Certainly, further studies are needed.
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Affiliation(s)
- Alessia Villani
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Massimiliano Scalvenzi
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | | | - Fabrizio Martora
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Francesco Cillo
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Flavia Raia
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Luca Potestio
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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