For statistical analysis the Statistical
For statistical analysis, the Statistical Package for Social Sciences (SPSS) was used (version 21.0; SPSSInc., Chicago, IL). Chi-square (x2) exact test was used for the comparison of categorical data, whereas Wilcoxon and Mann–Whitney U tests were used for the analysis of nonparametric variables based on the distribution pattern of the data. Data were expressed as “mean (standard deviation)” percent (%), minimum–maximum, odds ratio, 95% confidence interval, and “median (inter quartile range)” where appropriate p < 0.05 was considered statistically significant. Receiver operating characteristics (ROC) analysis was used.
Discussion Metastasis is accepted as unusual behaviour for BCC with very low rates. Recurrence is the main postoperative oncologic problem. Recurrence rates of the operated lesions depend on some characteristics of the tumour, but as mentioned presence of positive margin(s) after surgical excision is also important. There are studies on surgical margin involvement and recurrence rates of lesions with tumour positive margins. Kumar et al. reported that the rate of surgical margin involvement was 4.7% in 879 BCC (Kumar et al., 2000). In another study, Taylor and Barisoni found this biotin 100 mg rate to be 19% in 388 BCC lesions (Taylor and Barisoni, 1973). In a comparative study with a follow-up of 5 years, Nagore E. et al. reported that the recurrence rate was higher after incomplete resection (26%) than after complete resection (14%) (Nagore et al., 2003). In a previous study in our clinic, the rate of surgical margin involvement was found to be 14.9% in 154 BCC lesions operated and in these patient group (n:23) Recurrence was seen in 6 lesions (26.1%) during the follow-up (Bozan et al., 2015). The recurrence rates according to medical literature creates dilemma between re-operation and follow-up. Because close follow-up of the patients may be an acceptable solution without an immediate reoperation. Genetic alterations in the hedgehog signalling pathway most commonly causes loss of function of patched homologue 1 (PTCH1) and almost all basal-cell carcinomas contain these alternations. Vismodegib is now used as targeted molecule for this pathway in advanced BCC cases (Sekulic et al., 2012). Many studies show that there are abnormalities in the expression of EGFR in head and neck squamous cell carcinomas and invasive cutaneous squamous cell carcinomas and using targeted molecules in clinic is now accepted efficient in advanced cases (Chung et al., 2006; Sok et al., 2006; Toll et al., 2010). For BCC, there are a few clinic studies that investigates EGFR\'s role on tumour pathogenesis. Stelkovics, E. reported lower EGFR gene expression rates in BCC compared to SCC (Stelkovics et al., 2013). Our study is the first study that investigates the role of EGRF expression in recurrent cases with real time PCR method. Real time PCR has some advantages especially, high precision and sensitivity and also minimized risk of cross contamination (Klein, 2002). We found high expression rate of EGFR in tumoral tissues compared to healthy tissues in all subtypes of BCC. Also, expression rate was higher in cases with recurrence. EGFR expression was found higher in infiltrative cases too. This outcome is significant for tumour pathogenesis of BCC. Also for determining the postoperative prognosis of lesions with tumour positive margins this can be useful for clinicians. It may help to make the decision between follow-up and second surgery. Also, expression of EGFR can be seen as negative prognostic factor on recurrence for infiltrative subtyped lesions and this may change the width of the safe margins in primer surgery plan. The amount of the patient is one of the factors limiting the research. Selecting specific patient group that has both surgical margin positivity and after recurrence for study is the main factor that limits the number of lesions. Also, there was lack of statistical outcomes for nodular and superficial subtypes. Our study focuses on the role of EGFR overexpression specifically and outcomes for recurrent and infiltrative subtyped lesions are significant for both clinic and pathogenesis of BCC. For understanding EGFR\'s role on the pathogenesis of BCC, similar studies that focus on high number of patients with different clinic presentation has to be performed. So, this may have led to investigate effect of different targeted molecules for specific pathways of BCC.