Vismodegib is the first medication to be approved by the United States Food and Drug Administration and the European Medicines Agency for the treatment of locally advanced basal cell carcinoma in patients who are not candidates for surgery or radiotherapy and for the treatment of metastatic basal cell carcinoma. Therefore, this Hedgehog pathway inhibitor has generated high hopes among oncologists and dermatologists, since no alternative treatment is available for these patients, whose condition is difficult to manage and for whom no standard therapeutic approach has been established.

Initial enthusiasm has been tempered by the emergence of resistance, adverse effects that are sometimes poorly tolerated, possible liver toxicity, and a questionable increased risk of developing squamous cell carcinoma. However, experience with vismodegib as a neoadjuvant approach before surgery is growing. Similarly, we now know more about pulse dosing to diminish adverse effects and combination with other Hedgehog pathway inhibitors to increase effectiveness. Knowledge of the response to this drug in the patients we treat, therefore, is now particularly valuable; hence, the importance of the publication by Bernia et al.1 in this issue of Actas Dermosifiliográficas.