Neoadjuvant Hedgehog Pathway Inhibitor (HPI) therapy, utilizing sonidegib and vismodegib, has shown great potential in managing locally advanced basal cell carcinoma (laBCC). While effective, the tolerability of HPI therapy may be limited due to adverse effects (muscle spasms, alopecia). However, studies have shown a lower incidence of side effects with sonidegib, compared to vismodegib. In this report, we present the case of an 86-year-old male with laBCC on the left inner canthus treated successfully with neoadjuvant sonidegib for 25 weeks prior to Mohs micrographic surgery. This case highlights the utility of sonidegib as a potential neoadjuvant treatment modality for patients who are good candidates for surgery but would benefit from tumor reduction to achieve a more favorable outcome, especially in cosmetically sensitive areas. In addition, our patient experienced minimal side effects (muscle cramps at week 18) from sonidegib treatment. J Drugs Dermatol. 2025;24(3):329-331. doi:10.36849/JDD.8329.