PURPOSE OF REVIEW: We summarize the concept of a locally advanced basal cell 
carcinoma (laBCC) and present the current consensus definition. We also review 
the key pieces of primary research undertaken in the past year and how these 
affect the use of smoothened inhibitors in a clinical setting.
RECENT FINDINGS: Medium term follow-up (30 months) of patients treated with 
vismodegib shows an improvement in response rates for patients with laBCC. The 
safety profile of vismodegib demonstrated in the original ERIVANCE study has 
been replicated in a larger patient cohort in a repeat study. Sonidegib is a new 
smoothened inhibitor currently under investigation for treatment of laBCC, which 
demonstrates a comparable safety profile to vismodegib. The side-effects of 
smoothened inhibitors appear related to both dose and duration of treatment. The 
durability of response to vismodegib is uncertain, but has been observed to last 
for over a year following discontinuation of treatment.
SUMMARY: The understanding of the efficacy and safety of vismodegib has improved 
since its introduction in 2012. A broadening evidence base supports its use as a 
valid treatment for laBCC. However, questions remain as to how to integrate its 
use into existing pathways for treating laBCC and its long-term efficacy.