Introduction: Basal cell carcinoma (BCC) is the most frequent skin malignancy, with incidence increasing worldwide. Most BCC can be cured with local treatments (surgery or topical therapies), but advanced or recurrent forms require specific therapies. Significant developments targeting the sonic hedgehog signalization pathway have been made in the past years, paving the way for new therapies.Areas covered: This review details emerging drugs for BCC treatment, focusing on topical, intra-tumoral, and systemic therapies, such as new targeted therapies and immune checkpoint inhibitors. A literature search was conducted to identify ongoing studies using PudMed database and clinicaltrials.gov website.Expert opinion: Although surgery is and will probably remain the gold-standard therapy for BCC, treatment of recurrent, advanced, and metastatic tumors is evolving. Emergence of tumors resistant to targeted therapies lead the way to new approaches. Topical and intra-tumoral treatments represent alternatives to surgical morbidity, and many studies are ongoing. The first results of immune checkpoint inhibitors are encouraging in advanced and metastatic forms of the disease. New targeted therapies are needed to overcome or prevent the resistance to standard hedgehog pathway inhibitors.
Keywords: Basal cell carcinoma; immune-checkpoint inhibitors; locally advanced; sonic hedgehog pathway; surgery.