Computerized interactive educational tools used to improve use of sun-protective clothing and sunscreen: a randomized controlled study.

cells that have a compensatory amplification of genes downstream from SMO such as Gli. In individuals with multiple resistant BCCs, the isogenic background of a single individual may facilitate molecular studies of these resistant BCCs because some of the tumors may become resistant through multiple mechanisms. Future efforts to attack or prevent resistance in BCCs may involve the use of more than 1 drug at a time to target multiple pathways that contribute to abnormal basal cell growth. We were surprised that our case series did not show secondary resistance in the 8 patients with mBCC. It is possible that with longer follow-up times, mBCCs may be observed to acquire resistance while the patient is undergoing vismodegib treatment. In addition, larger sample sizes may be needed to observe this phenomenon: the regrowth rate we observed was only 1 in 5 in patients with laBCC. Because of the risk of regrowth, frequent skin examinations of patients undergoing treatment with vismodegib are essential to monitor for acquired resistance, even if the original tumor appears to be gone on clinical examination. When identified and biopsied early, these secondarily resistant BCCs are more likely to be treated effectively. Non-SMO inhibitor treatments such as surgical excision can be essential to optimize patient outcomes. With increased vismodegib usage, it is likely that tumor regrowth may be an increasing phenomenon. Future studies with larger numbers of patients observed for longer periods are needed confirm our observations, identify factors associated with regrowth, and characterize the molecular mechanisms by which regrowth occurs.