|Unintended ocular consequences of vismodegib in the treatment of locally advanced or multicentric basal cell carcinoma: a case series|| |
|Rifkin G., Gonzalez M.|
|University of Rochester, Ophthalmology, Rochester, United States|
|Purpose: To report on the unintended ocular consequences of vismodegib in the management of locally advanced or multicentric basal cell carcinoma.|
Methods: We present three patients with biopsy-confirmed locally advanced or multicentric BCC treated with vismodegib at 150 mg daily. Locally advanced or multicentric BCC can present a treatment challenge due to the cancer extent or location. In cases where surgery or radiotherapy is implausible or has failed, vismodegib, a hedgehog pathway inhibitor, has been used as medical therapy.
Results: The first patient presented in mid-2016 with left cheek and right orbit and lateral canthus multicentric BCC. She started vismodegib and experienced tumor regression. Tumor involution led to significant fibrosis of the right eyelids and orbit, with worsening right exposure keratopathy. She eventually required a right evisceration. As the BCC involuted, she experienced significant cicatrix of the left cheek and required left ectropion repair and radical excision of the remaining left cheek lesion with placement of an Integra graft, followed by radiation therapy and split thickness skin graft. The second patient presented in early 2017 with extensive involvement of the left centrofacial region, including the lower lid. He was started on vismodegib, but within days of initiating treatment, he was diagnosed with cecal adenocarcinoma and subsequently small cell lung carcinoma. Vismodegib was stopped and he was temporarily lost to follow up. He returned with ectropion for which he underwent left permanent tarsorrhaphy. The third patient presented in mid-2017 with locally advanced BCC extending from the temporal to the mandibular region, with extensive CN VII palsy and ectropion. He started vismodegib with tumor involution noted within days. He promptly underwent permanent tarsorrhaphy to address exposure and experienced significant tumor size reduction.
Conclusions: Anticipating the effects of vismodegib may allow eyes to be saved.
Associate Professor Mithra Gonzalez , University of Rochester , Rochester , United States
Assigned in sessions:
16.06.2019, 10:00-11:30, Free Papers/Rapid Fire, FP15, Oculoplastics, Refractive Surgery, Galliéni 1+2