Velleman Jos, Kaarela Outi, Vranckx Jan J
Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospitals Leuven, Leuven, Belgium.
Division of Plastic Surgery, Department of Surgery, Oulu University, Oulu, Finland.
Acta Chir Belg. 2021 Jun;121(3):198-203. doi: 10.1080/00015458.2019.1658943. Epub 2019 Sep 2.
Since the introduction of Vismodegib as treatment of recurrent locally advanced basal cell carcinoma (laBCC), clinicians are faced with new dilemmas: 'Can Vismodegib replace complex reconstructions?', 'What is the role of neoadjuvant use of Vismodegib?' and 'What is the best approach in case of complete clinical remission after Vismodegib in a neoadjuvant setting?'
Case report and literature review.
Complete dermoscopic remission after eight months Vismodegib was obtained in a patient with recurrent laBCC. Follow-up was 12 months. : Vismodegib shows histologic clearance in 42% of patients with operable basal cell carcinoma. Recurrence after neoadjuvant use of Vismodegib in laBCC was described. Moreover, histology revealed residual tumour cells in cases of complete clinical remission after 6 months Vismodegib.
Vismodegib cannot replace complex reconstructions. However, in unresectable laBCC, Vismodegib can provide a bridge to surgery. Due to the possibility of persistent tumour cells, we recommend imaging-assisted surgery and an imaging-based follow-up. In case of complete clinical remission after Vismodegib in a neoadjuvant setting, we recommend that Vismodegib be continued as long as the adverse effects are tolerated and an imaging-based follow-up is advised.
自维莫德吉被用于治疗复发性局部晚期基底细胞癌（laBCC）以来，临床医生面临着新的困境：“维莫德吉能否取代复杂的重建手术？”“维莫德吉新辅助治疗的作用是什么？”以及“在新辅助治疗中维莫德吉治疗后出现完全临床缓解的情况下，最佳方法是什么？”
病例报告及文献综述。
一名复发性laBCC患者在使用维莫德吉8个月后实现了皮肤镜下完全缓解。随访12个月。：维莫德吉在42%的可手术基底细胞癌患者中显示出组织学清除。文献描述了laBCC新辅助使用维莫德吉后的复发情况。此外，组织学显示在使用维莫德吉6个月后出现完全临床缓解的病例中存在残留肿瘤细胞。
维莫德吉不能取代复杂的重建手术。然而，在不可切除的laBCC中，维莫德吉可为手术提供桥梁。由于存在持续肿瘤细胞的可能性，我们建议进行影像辅助手术和基于影像的随访。在新辅助治疗中维莫德吉治疗后出现完全临床缓解的情况下，我们建议只要能耐受不良反应，就继续使用维莫德吉，并建议进行基于影像的随访。
