Metastatic spinal cord compression from basal cell carcinoma of the skin treated with surgical decompression and vismodegib: case report and review of Hedgehog signalling pathway inhibition in advanced basal cell carcinoma

Abstract

We report a case of a 66-year-old man with locally advanced and metastatic basal cell carcinoma (BCC) causing spinal cord compression, which was treated with spinal surgery and subsequent vismodegib. The patient presented with a large fungating chest wall lesion and a metastasis in T8 that was causing cord compression. He had neurosurgical decompression of the T8 lesion and fixation of the spine. Punch biopsy from the fungating chest wall lesion showed a BCC with some malignant squamous differentiation (basosquamous). Histopathological examination of the metastatic lesion in T8 at the time of surgical decompression identified features identical to the punch biopsy. The patient was referred to the oncology clinic for adjuvant treatment. In light of his metastatic disease and the large area over his chest wall that could not fully be covered by radiotherapy, he was treated with the novel oral Hedgehog signalling pathway (HHSP) inhibitor vismodegib, which led to marked improvement.

Basosquamous Carcinoma: A Commentary

“…On the other hand, the largest published cohort study with 1675 patients suggested that vismodegib is not associated with an increased risk of SCC while a systematic and a narrative review of the literature concluded that the existing evidence does not justify an association between vismodegib and SCC formation [ 31 , 51 , 52 ]. Moreover, there are three very recent case reports including four patients in total which provide preliminary evidence that vismodegib might be effective for difficult-to-treat BSC ( Table 2 ) [ 53 , 54 , 55 ]. In all of them, the lesions did not “transform” into purely squamous tumors but in contrast they completely remitted and in two cases the remission was maintained for a very long period of time [ 53 , 54 , 55 ].…”

“…Moreover, there are three very recent case reports including four patients in total which provide preliminary evidence that vismodegib might be effective for difficult-to-treat BSC ( Table 2 ) [ 53 , 54 , 55 ]. In all of them, the lesions did not “transform” into purely squamous tumors but in contrast they completely remitted and in two cases the remission was maintained for a very long period of time [ 53 , 54 , 55 ]. Although the effect of vismodegib on BSC treatment definitely requires further investigation in larger controlled studies, it could prove to be a future solution for locally advanced BSCs despite the presence of a squamous component in the tumors.…”

Classic and new strategies for the treatment of advanced melanoma and non-melanoma skin cancer

“…On the other hand, the cases of 4 patients with locally advanced BSC treated effectively with vismodegib have been reported recently. All lesions went into complete remission, which in two cases was maintained for a very long time ( 86 – 88 ).…”

Metastatic Basal Cell Carcinoma: An Unexpected Diagnosis in a Young Patient With Back Pain

“…They were often still present at the time of presentation, and spinal metastasis was in the setting of multiorgan involvement, particularly the regional lymph nodes. [33][34][35][36] Conversely, our patient presented to us 10 years after excision of a distant primary on his cheek with a 1-year history of back pain. Spinal metastasis was not accompanied by regional lymph node involvement.…”

“…They were often still present at the time of presentation, and spinal metastasis was in the setting of multiorgan involvement, particularly the regional lymph nodes. 33–36…”