Hedging Your Bets: A Resident’s Guide to Hedgehog Inhibitors for laBCC

In this episode of Cutaneous Miscellaneous, host Nicholas Brownstone, MD, welcomes Meenal Kheterpal, MD, Associate Professor of Dermatology at Duke University School of Medicine, for a comprehensive look at locally advanced basal cell carcinoma (laBCC) and the role of Hedgehog inhibitors (HHIs), a must-know topic for dermatology residents. Dr Brownstone opens with a board review of basal cell carcinoma, including risk factors, clinical variants, treatment selection, and when to consider Mohs surgery. He breaks down the Hedgehog signaling pathway, explaining how vismodegib and sonidegib work and their common side effects. In the main segment, Dr Kheterpal discusses how to identify and define laBCC in clinical practice, select appropriate candidates for HHI therapy, and integrate these agents into neoadjuvant treatment strategies. She shares practical pearls on counseling patients, managing adverse effects like muscle cramps, alopecia, and dysgeusia, and addressing teratogenicity concerns in reproductive-age patients. The episode also highlights tips for communicating treatment expectations confidently and applying clinical judgment beyond textbook definitions. Tune in to the full episode for board-focused insights and real-world takeaways for your future clinics.