INTRODUCTION

We report a 60-year-old female with a 30 year history of tanning bed usage presenting with a quarter sized area on the left shoulder which rapidly progressed. Biopsy confirmed nodular type basal cell carcinoma (BCC). CASE PRESENTATION

The lesion was determined to be too large for excision and the patient was referred to oncology. The patient was initially treated and responsive to 2 lines of hedgehog inhibitor treatment. However treatment was stalled due to hospitalization of patient with COVID-19 and the BCC progressed further. An additional line of hedgehog inhibitor therapy was attempted, despite which the BCC progressed.

MANAGEMENT

Treatment was transitioned to concurrent radiotherapy and chemotherapy with cisplatin, based on an extrapolation from treatment of head and neck squamous cell carcinoma. The patient responded well to concurrent therapy and after 5 cycles the lesion showed significant healing. Further follow-up at 8 weeks showed marked resolution with minimal erythema and scarring. OUTCOME

This case highlights the effective use of concurrent chemoradiation in the treatment of basal cell carcinoma which has progressed despite 2 lines of hedgehog pathway inhibitor treatment. Though literature is limited, in view of the excellent outcome achieved with chemoradiation, more research may be warranted to explore this modality of treatment.