While keratoacanthomas (KAs) and squamous cell carcinomas (SCCs) have been reported in response to a number of systemic drugs such as vemurafenib, sorafenib, or voriconazole,1- 3 their association with Smoothened inhibitors has not been previously noted. Herein, we report 2 cases of new KAs developing within 2 months of starting vismodegib therapy in individuals with no history of KAs or SCCs.
Figure. Development of distant keratoacanthomas (KAs) while undergoing vismodegib therapy. A, Clinical photograph of the rapid-onset 2-cm nodule on the right arm of patient 1 after 2 weeks of vismodegib treatment for an eyelid basal cell carcinoma (BCC). B, Histologic image from case 1 shows a cup-shaped, well-differentiated squamous cell carcinoma (SCC) invaginating into the dermis that was filled with keratin, consistent with KA (hematoxylin-eosin, original magnification ×100). C, Clinical photograph of KA development on the inferior medial brow of patient 2 after 7 weeks of vismodegib therapy for a periocular BCC. D, Histologic image shows a well-differentiated SCC, or KA (hematoxylin-eosin, original magnification ×100).
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