Vismodegib as Eye-Sparing Adjuvant Treatment for Orbital Basal Cell Carcinoma

Orbital invasion of basal cell carcinoma (BCCA) may lead to disfigurement, blindness, or even death1. Orbital exenteration, although disfiguring and blinding, is often the only option for cure when incompletely excised medial canthal tumors extend into the orbit.2 The Food and Drug Administration has recently approved a hedgehog pathway inhibitor3 with an adequate safety profile,4 Vismodegib (Erivedge, Genentech, CA), for oral treatment of basal cell nevus syndrome5 and locally advanced or metastatic BCCA.6 We report a patient with BCCA invading the medial orbit who was treated with oral vismodegib, resulting in near-total tumor shrinkage that permitted complete excision with clear surgical margins. Histopathologically, the excised tissue contained scattered residual tumor cells exhibiting squamous differentiation and low proliferative capacity.