title: The impact of neoadjuvant hedgehog inhibitor therapy on the surgical treatment of extensive basal cell carcinoma.
abstract: BACKGROUND
  Although hedgehog inhibitor therapy (HHIT) is offered as isolated medical treatment for extensive basal cell carcinoma (BCC), there is little evidence on the use of HHIT before definitive surgical intervention. In order to better define the utilization of HHIT for extensive BCC, we evaluated the impact of neoadjuvant HHIT on the subsequent surgical resection and reconstruction.
  
  
  METHODS
  An IRB-approved, retrospective chart review was performed of patients who received HHIT as initial treatment for extensive BCC. Patients who discontinued HHIT and underwent surgical resection were included. Evaluation included BCC tumor response to HHIT, operative data, pathological data, radiation requirements, and evidence of tumor recurrence.
  
  
  RESULTS
  Six patients were identified with tumors of the face/scalp (n = 4), trunk (n = 1) and upper extremity (n = 1). Hedgehog inhibitor therapy continued until tumors became unresponsive (n = 3, mean = 71 weeks) or side effects became intolerable (n = 3, mean = 31 weeks). In each case, a less extensive surgery was performed than estimated before HHIT. In 3 cases, significant bone resection was avoided. All resected specimens contained BCC. Four specimens exhibited clear margins. Postoperative radiation was performed in cases with positive margins (n = 2), and 1 patient experienced local recurrence. Length of follow-up was 5.7 to 11.8 months (mean = 8.23 months).
  
  
  CONCLUSIONS
  Although HHIT was not curative for extensive BCC, HHIT can decrease the morbidity of surgical treatment and increase the likelihood of curative resection. For patients with extensive BCC, a combined neoadjuvant use of HHIT and surgical treatment should be considered.
authors.affiliation: From the *Division of Plastic Surgery, †University of South Florida Morsani College of Medicine; ‡Cutaneous Oncology Department, Moffitt Cancer Center; §Department of Pathology, University of South Florida Morsani College of Medicine; and ∥Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, FL.
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Ching
authors.forename: Heather L
authors.initials: HL
authors.lastname: Curtis
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Braue
authors.forename: Ragini R
authors.initials: RR
authors.lastname: Kudchadkar
authors.forename: Tania I
authors.initials: TI
authors.lastname: Mendoza
authors.forename: Jane L
authors.initials: JL
authors.lastname: Messina
authors.forename: C Wayne
authors.initials: CW
authors.lastname: Cruse
authors.forename: David J
authors.initials: DJ
authors.lastname: Smith
authors.forename: Michael A
authors.initials: MA
authors.lastname: Harrington
mesh_terms: D000368:Aged; D000813:Anilides / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002280:Basal Cell Carcinoma / Q000188:drug therapy* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D062109:Dermatologic Surgical Procedures; D005500:Follow-Up Studies; D053823:Hedgehog Proteins / Q000037:antagonists & inhibitors; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011725:Pyridines / Q000627:therapeutic use*; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D000813:Anilides; D000970:Antineoplastic Agents; D053823:Hedgehog Proteins; C538724:HhAntag691; D011725:Pyridines