Complete pathologic clearance with vismodegib in advanced basal cell carcinoma of the scalp with cranial invasion

The management of advanced basal cell carcinoma (BCC) can be challenging and often involves a multi-disciplinary approach with dermatologists, plastic surgeons, and oncologists. Standard therapy for advanced BCCs has historically involved prompt excision and radiation; however, in recent years, management strategies utilizing hedgehog pathway inhibitors as neoadjuvant therapy have gained popularity. While controversy regarding management recommendations still exists, we present a case of advanced BCC with cranial involvement in an immunocompromised patient where the use of neoadjuvant vismodegib led to a favorable outcome and, surprisingly, complete the pathologic clearance of the tumor.