Sonidegib and Subsequent Photodynamic Therapy for Recurrent Nodular-Ulcerative Basal Cell Carcinoma of the Right Nose Post-Surgical Resection: A Case Report.

INTRODUCTION: Nodular-ulcerative basal cell carcinoma (NU-BCC) on the nose poses therapeutic challenges due to high recurrence rates and cosmetic concerns after wide excision. We present a case of recurrent nasal NU-BCC successfully managed with a sequential regimen of sonidegib, surgery, and photodynamic therapy (PDT) as a salvage strategy. CASE PRESENTATION: A 62-year-old female presented with a recurrent black, ulcerated lesion at the surgical margin of a previously excised nasal BCC. She refused extensive reoperation due to esthetic concerns and fear of surgery. She received 6-month oral sonidegib phosphate (200 mg/day, adjusted to alternate-day dosing based on adverse events), followed by local shaving excision and 4 sessions of aminolevulinic acid-PDT. Six months after completion, pathological examination confirmed complete tumor clearance, and no recurrence was observed during 1-year follow-up, with excellent nasal esthetic preservation. CONCLUSION: This sequential approach of sonidegib combined with surgery and PDT may be an effective and cosmetic-sparing option for selected patients with recurrent facial BCC who are unsuitable for or reluctant to undergo radical surgery. Further studies are warranted to validate its long-term efficacy.