An Analysis of Prognostic Markers in Basal Cell Carcinoma: Can We Predict Behavior?
MB Kraemer, R Patel, A Andea. The University of Alabama, Birmingham, AL
Background: Basal cell carcinoma (BCC) is a neoplasm with an indolent clinical course; however, rare cases behave in an aggressive fashion. While long duration, large size, and an infiltrative pattern have been associated with an increased risk for metastasis, the correlations are too weak to have clinical significance. Currently there are no reliable clinical, histopathologic, or immunohistochemical features that can distinguish aggressive from nonaggressive BCCs. This prompted us to evaluate the utility of several morphologic and immunophenotypic parameters as prognostic markers in BCC.
Design: We retrieved from our clinical database 10 cases of clinically aggressive BCC characterized by metastasis (1 case), large size >11cm (2 cases), aggressive local invasion (3 cases), or recurrence (5 cases). In addition we selected a control group of 56 BCCs (25 nodular, 3 micronodular, 23 infiltrative, 4 metatypical, 1 morpheaform). All cases were reviewed for the following parameters: histologic pattern, mitotic index (mitoses/mm2), apoptosis, necrosis, squamous differentiation, neuroendocrine morphology, (defined as high nuclear to cytoplasmic ratio, nuclear molding, homogeneous chromatin pattern, inconspicuous nucleoli) peripheral palisading, and ulceration. Immunohistochemistry for CK20, synaptophysin, and chromogranin was also performed. Percent of tumor cells staining as well as a staining intensity score was recorded for each case. Staining was considered positive when greater than 10% of cells stained.
Results: The only parameter that showed a significant difference in aggressive BCC vs. the control group was presence of necrosis 8/10 (80%) vs. 9/56 (16%), respectively, p<0.001. There were no differences in age distribution of patients with aggressive vs. nonaggressive BCC. Additionally, there was no difference in the number of mitoses, presence or absence of apoptosis, squamous differentiation, nuclear molding, neuroendocrine morphology, peripheral palisading, or ulceration between the nonaggressive and aggressive BCCs. Furthermore, there was no significant difference between groups in chromogranin expression or synaptophysin expression. None of the cases showed CK20 expression.
Conclusions: Our data showed that presence of tumor necrosis correlates strongly with an aggressive clinical course in patients with BCC. None of the other morphologic parameters or neuroendocrine markers analyzed were able to discriminate between the two groups.
Wednesday, March 24, 2010 1:00 PM
Poster Session VI # 89, Wednesday Afternoon