Extract

Dear Editor, Sonidegib, a Hedgehog inhibitor (HHI), effectively treats locally advanced basal cell carcinoma (BCC),1 and the efficacy of combining HHI with surgery is ­promising.2 During recent applications, we observed distinctive manifestations.

A 71-year-old Asian male presented with a large, brownish tumour on the left cheek (a), diagnosed as pigmented nodular BCC. He received sonidegib (200 mg daily) for 3 months followed by Mohs surgery, without experiencing adverse reactions. Preoperatively, the tumour volume decreased significantly, leaving a black plaque (b). Following complete surgical excision, pathology revealed complete tumour regression with abundant pigment granules and histocytes (c).

This suggests that pigmented BCCs that rapidly regress after HHI therapy may retain pigmentation, potentially causing clinical misjudgement as incomplete tumour regression.

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

The data underlying this article will be shared on reasonable request to the corresponding author.

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