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If lesions are not treated for years or relapse after surgery and\/or radiotherapy, they can become \u2018locally advanced\u2019 (\n                      <jats:styled-content style=\"fixed-case\">laBCC<\/jats:styled-content>\n                      ). In some challenging\n                      <jats:styled-content style=\"fixed-case\">BCC<\/jats:styled-content>\n                      patients, the risk of a significant functional\/aesthetic deficit advises against both complete surgical resection and radiotherapy. Medical therapies, such as the hedgehog pathway inhibitor (\n                      <jats:styled-content style=\"fixed-case\">HHI<\/jats:styled-content>\n                      ) sonidegib, may be helpful to make patients eligible for other potentially curative techniques or for the long\u2010term management of refractory cases or cases that are unsuitable for surgery and radiotherapy. A multidisciplinary board organized a Delphi consensus to understand the agreement around the cytoreductive HHI approach.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A Delphi questionnaire with 17 statements (with a 7\u2010point Likert scale) was administered via a customized web\u2010based platform to Italian specialists with clinical activity\/expertise in\n                      <jats:styled-content style=\"fixed-case\">laBCC<\/jats:styled-content>\n                      . In the second\u2010round physicians were asked to answer the same statements considering the interquartile range of each question as an index of their colleagues' responses.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Forty\u2010seven panelists, representative of the Italian territory, answered the questionnaire at the first round. For 16\/17 statements of the Delphi, at the second round, more than 75% of panelists assigned a score of 4 or more reaching agreement; these statements also reached a high consensus, as the panelists assigned similar scores, with a low interquartile range.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      In the absence of solid scientific evidence, this article offers consensus\u2010based recommendations on which patients may benefit from cytoreductive\n                      <jats:styled-content style=\"fixed-case\">HHI<\/jats:styled-content>\n                      , how to conduct the cytoreductive therapy, how to assess response to it and how to perform the surgery.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ijd.70103","type":"journal-article","created":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T18:22:33Z","timestamp":1761070953000},"page":"543-552","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Evaluation of Sonidegib Cytoreductive Activity in Locally Advanced Basal Cell Carcinoma Treatment: A Delphi Consensus"],"prefix":"10.1111","volume":"65","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8322-475X","authenticated-orcid":false,"given":"Paolo Antonio","family":"Ascierto","sequence":"first","affiliation":[{"name":"Melanoma Cancer Immunotherapy and Development Therapeutics Unit Istituto Nazionale Tumori IRCCS \u201cFondazione G. 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Gemelli IRCCS  Rome Italy"},{"name":"Dermatology, Department of Translational Medicine and Surgery Universit\u00e0 Cattolica del Sacro Cuore  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6025-0066","authenticated-orcid":false,"given":"Aurelio","family":"Portincasa","sequence":"additional","affiliation":[{"name":"Plastic Reconstructive and Aesthetic Surgery Clinical and Experimental Medicine Department University and Medical School of Foggia  Foggia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4185-9586","authenticated-orcid":false,"given":"Pietro","family":"Quaglino","sequence":"additional","affiliation":[{"name":"Dermatologic Clinic Department of Medical Sciences University of Turin  Turin Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9917-6633","authenticated-orcid":false,"given":"Paola","family":"Queirolo","sequence":"additional","affiliation":[{"name":"Division of Melanoma, Sarcomas and Rare Tumors IRCCS European Institute of Oncology  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2308-0982","authenticated-orcid":false,"given":"Luca","family":"Tagliaferri","sequence":"additional","affiliation":[{"name":"Radiation Oncology, Department of Diagnostic Imaging and Radiation Oncology Fondazione Policlinico Universitario A. 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