Cemiplimab-rwlc is indicated for locally advanced BCC previously treated with a hedgehog pathway inhibitor (HHI) or for whom HHI is not appropriate, or metastatic BCC (mBCC) previously treated with HHI or for whom HHI is not appropriate. The approval for mBCC is based on tumor response rates and durability of response noted in a trial. Medical oncologists often continue treatment initiated by dermatology, especially due to progression. Patient-specific factors leading to HHI inappropriateness include cachexia, peripheral vascular disease, and patient refusal due to alopecia. HHIs are typically continued for 8-12 weeks, with discontinuation if no response or intolerable toxicity. Cemiplimab was investigated in a phase 2 study, showing an overall response rate of 22% by independent central review, with a median progression-free survival of 10 months and a 12-month overall survival rate of 83%. Treatment-emergent adverse events (AEs) with cemiplimab include fatigue, GI AEs, and hypertension. HHIs are often discontinued due to AEs like muscle spasms, arthralgias, fatigue, taste changes, and weight loss, which may persist for weeks to months after discontinuation.