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Vismodegib Therapy and Xanthomatous Dermal Changes: Case Study in Basal Cell Carcinoma

By: Hope Craig, MSPH
Posted: Tuesday, April 20, 2021

In a case study published in The American Journal of Dermatopathology, researchers at the Mayo Clinic and The George Washington University highlighted a patient with basal cell carcinoma who clinically responded to vismodegib therapy and developed a novel xanthomatous dermal change on the right anterior chest.

“We hypothesize that the cellular debris, membrane lipids engulfed by foamy histiocytes, and the replacement of tumor represents microscopic tumor regression…. We report this case to raise awareness of the novel finding of dermal xanthomatous changes after vismodegib therapy in locally advanced basal cell carcinoma and postulate that this finding may be associated with treatment success,” commented Olayemi Sokumbi, MD, of the Mayo Clinic, and colleagues.

The 69-year-old man with locally advanced basal cell carcinoma was started on vismodegib, with “good clinical response” after 8 months. The patient was treated with wide local excision, which revealed an accumulation of foamy histiocytes replacing tumor cells within the skin, an uncommon phenomenon that seemed to be compatible with an effect from vismodegib therapy. CT scans and MRI images 10 months after excision revealed stable postoperative and post-therapeutic changes without evidence of recurrent mass. Due to the limited number of studies on such xanthomatous changes with this Hedgehog pathway inhibitor, it is challenging to predict continued response to this agent and predict relapse.

This case study brings attention to dermal xanthomatous changes after vismodegib therapy in locally advanced basal cell carcinoma, which may be associated with successful treatment. The patient will require close follow-up and treatment, if necessary.

Disclosure: The authors reported no conflicts of interest.



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