Daniel D. Von Hoff, M.D., Patricia M. LoRusso, D.O., Charles M. Rudin, M.D., Ph.D., Josina C. Reddy, M.D., Ph.D., Robert L. Yauch, Ph.D., Raoul Tibes, M.D., Glen J. Weiss, M.D., Mitesh J. Borad, M.D., Christine L. Hann, M.D., Ph.D., Julie R. Brahmer, M.D., Howard M. Mackey, Ph.D., Bertram L. Lum, Pharm.D., Walter C. Darbonne, M.S., James C. Marsters, Jr., Ph.D., Frederic J. De Sauvage, Ph.D., and Jennifer A. Low, M.D., Ph.D.: Inhibition of the Hedgehog Pathway in Advanced Basal-Cell Carcinoma Basal-cell carcinoma, the most common skin cancer in the United States, comes with an estimated annual incidence of 0.1 to 0.5 percent.1,2 The condition is largely caused by exposure to ultraviolet radiation, but there are other risk factors.3,4 Surgery treatments most situations of basal-cell carcinoma, however in a few patients there’s progression to life-threatening, unresectable, advanced5 locally,6 or metastatic7,8 tumors.Miyamotoi disease is a likely cause of this full case of meningoencephalitis. The disease that was observed, seen as a a progressive cognitive decline, was nonspecific and might have been misdiagnosed, although it was treated as a case of Lyme neuroborreliosis successfully. However, the microscopical detection of an extraordinary density of morphologically specific spirochetes in the CSF of our patient attracted additional scrutiny. It’s possible that similar cases elsewhere in the United States have been attributed to Lyme neuroborreliosis. The patients would have been treated with intravenous antibiotic agents and may have recovered with no sequelae.