There is a paucity of information relating to the treatment of periocular BCC (basal cell carcinoma) with Vismodegib, a first-in-class Hh (Hedgehog) pathway inhibitor. Long term data is not available and few cases are described. The purpose of this case series and literature review is to demonstrate the use of Vismodegib in 2 separate cases of locally advanced BCC.

Two patients undergoing Vismodegib treatment for periocular BCC are presented and followed up, the first for a 6 month period and the second currently undergoing treatment.

We present 2 patients undergoing treatment for locally advanced periocular BCC. The first patient was treated for a large ulcerating BCC at the medial canthus invading the anterior orbit. Surgical options including exenteration were explored, but a decision to use Vismodegib resulted in a significant reduction in the size of the lesion over a 3 month period. Following mapping biopsies, surgical excision and a flap based local reconstruction was completed.

The second patient has a large medial canthal BCC. Vismodegib treatment has commenced, and images of the clinical course are presented.

This case series and review of literature adds to the existing body of evidence that in some circumstances Vismodegib may be a preferable option where other options include extensive and radical surgery, or where the lesion is unresectable. It seems to be a well-tolerated and effective treatment in advanced BCC.