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Ocular preservation with neoadjuvant vismodegib in patients with locally advanced periocular basal cell carcinoma
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  • Published on:
    Neoadjuvant Vismodegib plus Mohs Surgery for Locally Advanced Periocular Basal Cell Carcinoma
    • Abel Gonzalez, Surgeon Instituto Alexander Fleming - Instituto Oncología Angel H. Roffo
    • Other Contributors:
      • Dardo Etchichury, Surgeon

    Dear Editor,
    We read with great interest the excellent paper by Sagiv and collegues Ocular preservation with neoadjuvant Vismodegib in patients with locally advanced periocular basal cell carcinoma.1
    The article is a great contribution for a topic with a growing, but still limited worldwide experience. Our interest is to discuss the surgical approach after neoadjuvant Vismodegib.
    The authors present a patient with a 5x4cm locally advanced periocular basal cell carcinoma (LAP-BCC) with small nerve perineural invasion (>0.1mm) involving lower eyelid, inner canthus and cheek. The patient showed a significant response after 10 months of Vismodegib. Anyhow, it was clearly a partial response with 3 suspicious areas of BCC after treatment. The authors decided to treat separately each area with surgery, and histology (en face sections) confirmed the presence of tumor in two. The reconstructive outcome was excellent, and at the time of publication the patient was free of disease, 11 months after surgery.
    We agree with the authors, when they consider as a limitation the fact that “surgery did not always include the entire area of the original tumor”.
    Most studies involving smoothened inhibitors thus far have measured clinical tumor shrinkage but not true histologic margin control. Even after a complete clinical response (CCR), there is no way to assure that it will result in a complete histological clearance (CHR).
    Several authors discussed thi...

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    Conflict of Interest:
    None declared.