Triple Hedgehog Pathway Inhibition for Basal Cell Carcinoma.

Vismodegib, a potent inhibitor of the hedgehog pathway, is an effective treatment for advanced basal cell carcinoma. More recently, it has become recognized that other oral and topical medications exist that also inhibit this pathway. Multifocal inhibition has been shown to work more efficaciously than a single pathway inhibition when treating melanocytic tumors. The authors report the successful treatment of a patient with advanced basal cell carcinoma using the combination of vismodegib, itraconazole, and imiquimod, each of which inhibits a different part of the hedgehog pathway.