Without a formal staging system, advanced basal cell carcinoma is defined by the interplay of tumor size, anatomic site, depth, histology, and host factors that may not be apparent on initial biopsy.
Although hedgehog pathway inhibitors are considered first-line systemic therapy for locally advanced disease, surgical fatigue and patient preference may warrant earlier discussion of oral treatment than current practice patterns reflect.
Multimodal planning for advanced basal cell carcinoma extends beyond labeled indications, with neoadjuvant hedgehog inhibition, adjuvant radiation, and immune checkpoint inhibitors each occupying a defined place in treatment sequencing.
Distinct pharmacokinetic profiles, including volume of distribution, half-life, and time to steady state, differentiate the two approved hedgehog inhibitors and can be translated into patient-facing counseling during shared decision-making.
