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The development of the hedgehog pathway inhibitor vismodegib provides a new treatment option for metastasised and locally advanced basal cell carcinoma in which surgical excision or radiotherapy is contraindicated. Only a fraction of patients with basal cell carcinoma are eligible for this therapy, but it is effective in the majority of those who do receive vismodegib. However, development of tumour resistance is quite common and adverse events frequently lead to discontinuation of therapy. Intermittent treatment or combination therapy could reduce the occurrence of tumour resistance and diminish toxicity. We present three patients who were successfully treated with vismodegib: a 73-year-old man with locally advanced basal cell carcinoma, an 82-year-old man with basal cell carcinoma that had metastasised to the lungs, and a 42-year-old man with Gorlin syndrome.

Background: Generally basal cell carcinoma can be simply and curatively treated. However, large and long-standing tumours can be locally very destructive and in rare cases even metastasize. Hedgehog pathway inhibitors such as vismodegib constitute a new and promising therapy for metastatic or locally advanced basal cell carcinoma., Case Description: We describe a patient with metastasized basal cell carcinoma and basal cell nevus syndrome who, in the context of a study, was successfully treated with vismodegib. The main undesirable effects in our patient were muscle cramps, loss of taste, nausea and hair loss., Conclusion: Basal cell carcinoma is potentially a locally destructive skin tumour that only very rarely metastasizes. Hedgehog pathway inhibitors such as vismodegib can be administered in a selected group of patients with basal cell carcinoma.