The HHI Playbook: Practical Pearls for Treating Locally Advanced Basal Cell Carcinoma 

The Spot Check, host Jamie Restivo, MPAS, PA-C, welcomes Scott Dinehart, MD, board-certified dermatologist, Mohs surgeon, and founder of Arkansas Dermatology, for a frank and myth-busting discussion on hedgehog pathway inhibitors (HHIs) and their role in treating locally advanced basal cell carcinoma (BCC). 

Dr Dinehart, one of the first fellowship-trained Mohs surgeons in Arkansas, shares his firsthand experience with vismodegib and sonidegib, emphasizing that PAs and NPs are ideal prescribers for these agents and should feel confident managing this patient population. He addresses common misconceptions about efficacy and tolerability head-on, noting that “These drugs work—and they work in more than 90% of patients.” 

 

Together, they explore clinical indications for sonidegib and discuss expanding the mindset beyond large, neglected tumors. Dinehart urges clinicians to consider HHIs for older adults, nursing home residents, patients with multiple lesions, or those who simply prefer to avoid surgery or radiation. “Shrinkage”, he reminds listeners, is always a win—improving quality of life and often allowing for simpler, less invasive procedures down the line. 

Supplemental Clinical Resources:

To support adoption of HHIs in everyday practice, Dr Dinehart has provided two references: 

Sonidegib Quick Reference Sheet: summarizes key prescribing information, laboratory guidance, drug-interaction tables, and L-carnitine dosing details for muscle-cramp prevention. 

HHI Dosing Calendar: a visual schedule illustrating his modified twice-weekly regimen to aid patient counseling and adherence tracking. 

For clinicians who have additional questions or would like to discuss treatment approaches, Dr Dinehart welcomes inquiries at smdinehart@gmail.com.