Abstract: The Impact of Neoadjuvant Hedgehog Inhibitor Therapy on the Surgical Treatment of Extensive Basal Cell Carcinoma (Plastic Surgery 2014)

Monday, October 13, 2014: 8:25 AM

Jessica A Ching, MD , Division of Plastic Surgery, University of South Florida, Tampa, FL

Heather L Curtis, MD , Plastic Surgery, University of South Florida, Tampa, FL

Jonathan A Braue, BS , University of South Florida, Tampa, FL

Ragini Kudchadkar, MD , Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL

Tania Mendoza, MD , Pathology, University of South Florida, Tampa, FL

Jane Messina, MD , Cutaneous Oncology & Anatomic Pathology, Moffitt Cancer Center, Tampa, FL

C. Wayne Cruse, MD , Plastic Surgery, University of South Florida, Tampa, FL

Michael A Harrington, MD, MPH , Plastic Surgery, University of South Florida, Tampa, FL

Presentation PDF file

Purpose:

While surgical excision is the mainstay of treatment for basal cell carcinoma (BCC), some patients with extensive BCC are poor candidates for excision because of significant anticipated deformity and reconstruction. With the recent FDA approval of hedgehog inhibitor therapy (HHIT) for extensive BCC, we sought to analyze the effect of neoadjuvant HHIT on the subsequent surgical treatment of patients with extensive BCC.

Methods:

An IRB-approved, retrospective chart review was performed of patients who received HHIT as primary treatment for extensive BCC prior to October 2013. Patients who stopped HHIT and underwent surgical resection were included. Data included: BCC lesion response to HHIT, operative and pathology reports, radiation requirement, and recurrence of BCC.

Results:

Five patients were identified. Lesion location was face/scalp (n=4) and upper extremity (n=1). All patients received HHIT until unable to tolerate its side effects (n=2, mean=32.5 weeks) or lesion response subsided (n=3, mean=71 weeks). After HHIT, all tumor burdens decreased in surface area and/or tissue depth, and ultimately, less sizeable operations were performed than were proposed prior to the HHIT. In two cases, segmental mandibulectomy was avoided (one patient shown in Figures 1 and 2). BCC was present in all resected specimens, with 3 specimens exhibiting clear margins and no postoperative recurrence. Cases with positive margins (n=2) were treated with postoperative radiation; one patient experienced considerable local recurrence. Length of follow up was 7.6 to 11.8 months (mean=8.7 months).

Conclusions:

HHIT is a viable option for neoadjuvant treatment of extensive BCC, potentially improving the morbidity of surgical treatment.

Figure 1. Patient with BCC involving left chin, lip, and mandible prior to HHIT.

Figure 2. Same patient seen in Figure 1.This is the site of BCC exhibiting significant regression after HHIT at the time of resection and local flap reconstruction. Segmental mandibulectomy was avoided in this patient.

24847 The Impact of Neoadjuvant Hedgehog Inhibitor Therapy on the Surgical Treatment of Extensive Basal Cell Carcinoma