Fig. 1.

Lower eyelid basal cell carcinoma (BCC) treated with sonidegib. a A 73-year-old man with a 20-year history of multiple BCCs at his back, chest, nose, and ear presented with marked blepharitis and ulcered lesion in the center of the lower eyelid margin with clinical suspicion of a morphea-type BCC. b Hematoxylin-eosin (HE) staining of the biopsy shows basaloid nests as well as typical gap formation between tumor cell nests and the surrounding stroma (arrow) (HE: × 10), compatible with BCC. c Following treatment with sonidegib for 6 months, there was marked persisting blepharitis and lower eyelid ectropion, suspicious for BCC recurrence. d HE staining of the second full-thickness biopsy shows tiny foreign body granulomas and neutrophil adjacent to the deep epidermis (HE: × 10). Insert demonstrates the eyelid margin was edematically irritated without stronger layering disorder or cytological atypia, presenting with hypokeratosis (HE: × 20), ruling out BCC recurrence