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Langerhans cell histiocytosis (LCH) is an infrequent clonal proliferative disorder of myeloid dendritic cells. It has a wide variety of cutaneous manifestations and retains the possibility of systemic implications. Because LCH is predominantly a disease of childhood, there are wellestablished clinical definitions, as well as guidelines regarding workup and treatment, in the context of pediatric disease. Here we present a case of isolated cutaneous LCH in an adult male, followed by a discussion of our diagnostic plan and treatment course. The patient exhibited a small, excoriated, yellow papule on his inferior forehead during a skin examination. The specimen underwent tangential shave biopsy; histopathologic evaluation with appropriate immunohistochemical staining confirmed a diagnosis of cutaneous LCH. After thorough investigation via serologic and imaging diagnostics, we confirmed isolated cutaneous disease. The patient underwent wide local excision (WLE) with no evidence of recurrence. It is crucial to appropriately screen all patients diagnosed with cutaneous LCH for internal organ involvement. The authors aim to highlight the need for further investigations to ultimately dictate standardized management and treatment for isolated cutaneous LCH in the adult population.

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Basal cell carcinoma (BCC) is the most common cancer worldwide, with an increasing annual incidence 1,2 -In patients with advanced BCC, lesions become extensively locally invasive or metastatic, and traditional first-line surgical treatment may be contraindicated 3 • Hedgehog pathway inhibitors (HHIs) represent an alternate treatment option for patients with advanced BCC 4 -HHIs block the aberrant Hedgehog pathway activation that allows transcription of glioma-associated oncogene transcription factors and activation of target genes for tumorigenesis and angiogenesis during development of BCC (Figure 1) 5 -Most HHIs prevent Hedgehog signaling by binding to and preventing activation of transmembrane protein Smoothened 5

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