Poulalhon Nicolas, Dalle Stéphane, Balme Brigitte, Thomas Luc
Department of Dermatology, Centre Hospitalier Lyon Sud, Pierre Bénite, France.
Dermatology. 2015;230(2):101-4. doi: 10.1159/000368350. Epub 2015 Jan 24.
Vismodegib therapy achieves a breakthrough in patients with locally advanced basal cell carcinoma (BCC). Yet, long-term safety of hedgehog pathway inhibitors remains to be established, while drug resistance is becoming a new challenging issue.
We report the case of a 90-year-old male initially referred for a locally advanced BCC of the nose. He had been previously treated by topical 5-fluorouracil for an adjacent microinvasive squamous cell carcinoma (SCC), with complete clinical response. Afterwards, vismodegib was initiated to treat his BCC. At week 16, both tumor and tumor ulceration obviously progressed. Palliative rhinectomy was performed. Histological examination found a deeply invasive SCC.
Although our case must be interpreted with caution, a role of vismodegib as a promoter of cutaneous SCC should be considered, consistently with recently published evidence. Physicians should perform new biopsies whenever in doubt about new and/or progressive skin lesions in patients receiving hedgehog pathway inhibitors.
维莫德吉治疗在局部晚期基底细胞癌（BCC）患者中取得了突破。然而，刺猬通路抑制剂的长期安全性仍有待确定，而耐药性正成为一个新的具有挑战性的问题。
我们报告了一名90岁男性的病例，他最初因鼻部局部晚期基底细胞癌前来就诊。他曾因相邻的微侵袭性鳞状细胞癌（SCC）接受局部5-氟尿嘧啶治疗，临床完全缓解。之后，开始使用维莫德吉治疗他的基底细胞癌。在第16周时，肿瘤和肿瘤溃疡明显进展。进行了姑息性鼻切除术。组织学检查发现为深部浸润性鳞状细胞癌。
尽管我们的病例必须谨慎解读，但应考虑维莫德吉作为皮肤鳞状细胞癌促进剂的作用，这与最近发表的证据一致。当对接受刺猬通路抑制剂治疗的患者的新的和/或进展性皮肤病变存在疑问时，医生应进行新的活检。
