PMC10013465_01
Case 1. (A) Bulky recurrence on the vertex of cSCC at cycle 1 (C1) of cemiplimab; (B) partial response at C23 of cemiplimab and C4 of sonidegib; (C) stable disease at C30 of cemiplimab and C10 of sonidegib. (D) Infiltrative BCC extended to the right external auditory meatus at C18 of cemiplimab and C1 of sonidegib; (E) partial response at C23 of cemiplimab and C4 of sonidegib; (F) complete response of BCC at C30 of cemiplimab and C10 of sonidegib.
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The patient presented with a large and painful vegetating mass of the vertex characterized by a fibrinous central ulcerated-hemorrhagic area and peripheral necrosis ( Figure 2A ). On October 2019, the patient started cemiplimab 350 mg intravenously every 3 weeks, achieving a dimensional reduction of the cSCC on the vertex ( Figures 2B, C ) and numerical reduction of the multiple diffuse BCCs, without reporting immune-related adverse events (irAEs). At clinical examination, the ulcerated lesion was infiltrating the external auditory meatus, and a biopsy confirmed the clinical suspect of BCC (cT3) ( Figure 2D ). A prompt clinical response on the laBCC was observed ( Figures 2E, F ), while the cSCC at the vertex maintained clinical and radiological partial response.
PMC10013465_02
Case 2. (A) Retroauricular BCC infiltrating the right auricular cartilage at C1 of sonidegib; (B) partial response at C10 of sonidegib; (C) complete response at C10 of cemiplimab. A computer tomography scan of the neck reported a complete response of the cSCC nodal relapse at C7 of cemiplimab.
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An 83-year-old Caucasian man with a history of multiple excisions of head and neck cSCCs and BCCs was evaluated for the onset of 3-cm right fronto-temporal recurrence of cSCC (cT2) and a painful right retroauricular BCC infiltrating the auricular cartilage (cT3) ( Figure 3A ). After 2 months of sonidegib therapy, a significant clinical reduction of the retroauricular BCC was achieved ( Figure 3B ). At the last follow-up on 22 November 2022, the patient completed 27 cycles of cemiplimab, obtaining a complete response with clinical benefit ( Figure 3C ) without significant AEs from the sequential HHi/anti-PD-1 therapy.