Colné J, Angioi-Duprez K, Granelle F, Maalouf T
Département d'ophtalmologie, CHRU Nancy, 25, rue Lionnois, 54000 Nancy, France.
Département d'ophtalmologie, CHRU Nancy, 25, rue Lionnois, 54000 Nancy, France.
J Fr Ophtalmol. 2021 Oct;44(8):1243-1248. doi: 10.1016/j.jfo.2021.04.003. Epub 2021 Aug 18.
Basal cell carcinoma (BCC) is the most frequent cutaneous carcinoma. Its incidence is constantly increasing, primarily due to sun exposure during the two first decades of life. The lower lid and medial canthus are the most common locations. In the majority of cases, surgery with sufficient margins is the first-line treatment. In the case of inoperable tumors (extensive lesions, poor general health, high surgical morbidity, unacceptable cosmetic sequelae), oral chemotherapy can be suggested. We report the follow-up of 4 patients with advanced non-metastatic basal cell carcinoma (BCC) treated with oral chemotherapy (sonigegib). All patients were female with a mean age of 80years. The first patient had an infiltrative BCC of the right lower lid with orbital invasion, the second a nodular BCC of the right inferior lid with massive cutaneous and orbital invasion extending to the controlateral medial canthal angle, the third an advanced infiltrative BCC invading both orbits and nasal cavities, and the fourth, an infiltrative BCC with extension to the ipsilateral skin of the face. The diagnosis of BCC was confirmed by multiple biopsies in our four patients prior to starting chemotherapy. Because of the locally advanced lesions, surgery was contraindicated in all cases, chemotherapy was undertaken (sonidegib 200mg daily), and ophthalmological and dermatological examinations were performed every 3months. In all 4 patients, the outcome was very favorable, with one clear regression in tumor size and infiltration and 3 partial regressions. Many side effects were noted, including nausea, muscle cramping, dysgeusia resulting in significant weight loss, and malnutrition in the elderly patients. The treatment had to be discontinued after 11months in the patient with total macroscopic regression because of major side effects. The treatment is still underway for the other patients and will be continued as long as a clinical benefit is observed. The treatment will be discontinued if intolerable side effects develop. Oral chemotherapy (sonidegib) is an effective alternative treatment when surgery cannot be realized, especially in the case of extensive infiltrative non-metastatic BCC.
基底细胞癌（BCC）是最常见的皮肤癌。其发病率持续上升，主要归因于生命最初二十年中的阳光暴露。下眼睑和内眦是最常见的发病部位。在大多数情况下，进行足够切缘的手术是一线治疗方法。对于无法手术的肿瘤（广泛病变、全身健康状况差、手术并发症发生率高、美容后遗症难以接受），可建议采用口服化疗。我们报告了4例接受口服化疗（索尼吉布）治疗的晚期非转移性基底细胞癌（BCC）患者的随访情况。所有患者均为女性，平均年龄80岁。首例患者为右下眼睑浸润性BCC伴眼眶侵犯；第二例为右下眼睑结节性BCC，伴有广泛的皮肤和眼眶侵犯，延伸至对侧内眦角；第三例为晚期浸润性BCC，侵犯双侧眼眶和鼻腔；第四例为浸润性BCC，延伸至同侧面部皮肤。在开始化疗前，我们的4例患者均通过多次活检确诊为BCC。由于病变局部进展，所有病例均禁忌手术，遂进行化疗（索尼吉布每日200mg），并每3个月进行眼科和皮肤科检查。所有4例患者的预后都非常良好，1例肿瘤大小和浸润明显消退，3例部分消退。观察到许多副作用，包括恶心、肌肉痉挛、味觉障碍导致体重显著减轻以及老年患者营养不良。肿瘤完全肉眼消退的患者在11个月后因严重副作用不得不停止治疗。其他患者的治疗仍在进行，只要观察到临床获益就会继续。如果出现无法耐受的副作用，治疗将停止。当无法进行手术时，口服化疗（索尼吉布）是一种有效的替代治疗方法，尤其是在广泛浸润性非转移性BCC的情况下。
