Expression of vascular endothelial growth factor is a clinically useful predictor for aggressive basal cell carcinoma

Jong Soon Choi; Dong Chan Lee; Hee Kyung Chang

doi:10.7180/kmj.2018.33.1.75

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Choi, Lee, and Chang: Expression of vascular endothelial growth factor is a clinically useful predictor for aggressive basal cell carcinoma

Original Article

Kosin Medical Journal 2018;33(1):75-84.

Published online: 21 January 2018

DOI: https://doi.org/10.7180/kmj.2018.33.1.75

Expression of vascular endothelial growth factor is a clinically useful predictor for aggressive basal cell carcinoma

Jong Soon Choi¹, Dong Chan Lee², Hee Kyung Chang³

¹Department of Family Medicine, College of Medicine, Kosin University, Busan, Korea

²Department of Plastic Surgery Medicine, Ritz Plastic Surgery Clinic, Geoje, Korea

³Department of Pathology, College of Medicine, Kosin University, Busan, Korea

Corresponding Author: Hee Kyung Chang, Department of Pathology, College of Medicine, Kosin University, 262, Gamchen-ro, Seo-gu, Busan 49267, Korea Tel: +82-51-990-6476 Fax: +82-51-990-3045 E-mail: fmcjs@naver.com

Received 29 November 201713 December 2017 Accepted 22 January 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives

Basal cell carcinoma (BCC) tumors are locally invasive but rarely metastatic. However, aggressive metastatic variants are being increasingly reported in elderly people. Here we investigated the clinical utility of vascular endothelial growth factor (VEGF) as a predictive biomarker for aggressive BCC variants.

Methods

Thirty-five pathologically confirmed cases of BCC that underwent surgical removal in the Plastic Surgery Department between January 1, 2011 and December 31, 2012 were studied. VEGF expression was analyzed in formalin-fixed paraffin-embedded tumor tissue by immunohistochemical staining. Positive staining was defined as more than 10% of the tumor cells showing immunoreactivity. The associations of VEGF expression with various clinicopathologic parameters were analyzed.

Results

The face was the most prevalent site (28/35), with 15 cases from the nose, 6 cases from the eyelid, and 5 cases from the cheek. The patients were aged between 41 and 86 years, with a mean age of 69.26 ± 173.903 years. The mean BCC size was 1.34 ± 3.853 cm, with a range of 0.3 cm to 12.0 cm. The mean tumor invasion depth from the basement epidermal membrane was 0.17 ± 0.035 cm, with a range of 0.03 cm to 1.10 cm. A mean of 5.66 ± 20.938 intraoperative frozen section slides were examined. VEGF was not expressed in 14 of the 35 patients (40.0%), whereas 42.9% of the patients had low expression and 17.1% of the patients had high expression. VEGF expression was significantly associated with age (P = 0.022), size (P = 0.030), site (P = 0.013), tumor invasion depth (P = 0.019), and number of intraoperatively frozen sections (P = 0.003).

Conclusions

These results suggest that VEGF expression as assessed by immunohistochemistry can predict aggressive or poor prognosis in BCC.

Keywords: Basal cell carcinoma, Biomarker, VEGF

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Fig. 1.

The pathologic findings of Basal cell carcinoma of skin on the face. (H-E, x100)

Fig. 2.

The expression of VEGF by immunostaining in the basal cell carcinoma (x100) (A) Negative expression of VEGF in the basal cell carcinoma (B) Low-expression of VEGF in the basal cell carcinoma (C) High-expression of VEGF in the basal cell carcinoma

Table 1.

The association of VEGF expression with clinicopathologic variables in the basal cell carinoma

variables	total (n = 35) (%)	Cases of VEGF expression				Pvalue according to positivity (expression level)
		negative(%) (n = 14)	Positive reaction(n = 21)
		negative(%) (n = 14)	total of Positivity (%)	low(%) (n = 15)	high(%) (n = 6)
mean age	69.26 ± 103.903	63 ± 14.486	73.41 ± 10.915	73.47 ± 10.954	73.33 ± 10.875	0.000 (0.022)
gender male	15(42.9)	7(46.7)	8(5.5)	5(33.3)	3(20.2)	0.096 (0.120)
female	20(53.1)	7(25.0)	13(75.0)	10(60.0)	3(15.0)
mean size (cm)	1.34 ± 3.852	0.709 ± 0.289	1.645 ± 1.875	1.923 ± 2.897	1.367 ± 0.582	0.000 (0.030)
site						0.002 (0.013)
face	28(80.0)	9(32.1)	19(67.9)	14(50.0)	5(17.9)
non-face	7(20.0)	5(64.4)	2(33.6)	1(14.3)	1(14.3)
invasion depth(mm)	1.7 ± 0.035	1.21 ± 0.092	1.79 ± 0.495	2.21 ± 0.26	1.63 ± 0.71	0.000 (0.019)
numbers of frozen section	5.66 ± 20.94	3.29 ± 2.76	8.02 ± 5.121	6.20 ± 4.13	9.83 ± 6.11	0.000 (0.003)

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