title: Lichenoid reaction as a potential immune response marker of intratreatment histological response during successful vismodegib treatment for a giant basal cell carcinoma.
abstract: We report an 83 year-old patient with a 13 × 7.5 cm(2) basal cell carcinoma (BCC) successfully treated with the combination of vismodegib and minimal surgery. On Day 109, a 0.9 cm papule suspicious for residual BCC was seen centrally within a large pink atrophic plaque. This lesion was excised; pathology confirmed BCC with negative surgical margins. Simultaneously, suspecting noncontiguous histologic response, we performed 21 biopsies at the periphery of the pretreatment tumor location. Seventeen (17/21, 81%) revealed lichenoid dermatitis. No tumor was seen on any. We believe the lichenoid dermatitis observed is a novel finding for two reasons. First, it may be considered a marker of a positive intratreatment response. This may help guide clinicians on the optimal treatment duration of vismodegib to maximize efficacy and mitigate side effects. Second, we think it suggests an additional mechanism of vismodegib action, possibly via local immune effects. Further investigations are warranted.
authors.affiliation: Saint Louis University Departments of Dermatology, Internal Medicine, Ophthalmology and Otolaryngology-Head and Neck Surgery, Saint Louis University Cancer Center, St. Louis, Missouri.
authors.forename: Scott W
authors.initials: SW
authors.lastname: Fosko
authors.affiliation: Saint Louis University Department of Dermatology, St. Louis, Missouri.
authors.forename: Melinda B
authors.initials: MB
authors.lastname: Chu
authors.affiliation: Saint Louis University Department of Dermatology, St. Louis, Missouri.
authors.forename: Adam R
authors.initials: AR
authors.lastname: Mattox
authors.affiliation: Saint Louis University, Department of Internal Medicine, Division of Hematology and Medical Oncology, St. Louis, Missouri.
authors.forename: John M
authors.initials: JM
authors.lastname: Richart
authors.affiliation: Saint Louis University Department of Dermatology, St. Louis, Missouri.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Burkemper
authors.affiliation: Stony Brook Medicine, Department of Dermatology, Stony Brook, New York.
authors.forename: Jordan B
authors.initials: JB
authors.lastname: Slutsky
mesh_terms: D000369:Aged, 80 and over; D000813:Anilides / Q000009:adverse effects / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001706:Biopsy; D002280:Basal Cell Carcinoma / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D006801:Humans; D017512:Lichenoid Eruptions / Q000139:chemically induced* / Q000276:immunology / Q000473:pathology; D008297:Male; D020360:Neoadjuvant Therapy / Q000009:adverse effects; D011725:Pyridines / Q000009:adverse effects / Q000627:therapeutic use*; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome; D047368:Tumor Burden
chemical_list: D000813:Anilides; D000970:Antineoplastic Agents; C538724:HhAntag691; D011725:Pyridines
keywords: basal cell carcinoma; lichenoid dermatitis; neoadjuvant; treatment response; vismodegib