What’s your approach to treating multiple facial BCCs in gorlin syndrome?   

Patients get surgically exhausted, and often fearful of radiation or is not acceptable, I use twice weekly erivedge even with multiple comorbidities not only suppresses but often complete resolution of lesions. Intermittent dosing has a 12 day half-life and I take advantage of that.

We also like to use vismodegib or sonedegib to manage the multiple BCCs that these patients acquire. There’s also the option of treating only the large or bothersome BCCs with procedures such as Mohs, ED&C, excision. Discuss with the patients their options in the setting of likely surgical...