title: Presence of ulceration, but not high risk zone location, correlates with unfavorable histopathological subtype in facial basal cell carcinoma.
abstract: BACKGROUND
  Basal cell carcinoma (BCC) has been stratified into low- and high-risk according to their propensity for local recurrence. Risk factors for recurrence include histologic subtype, anatomic location (i.e. H-zone of the face), horizontal diameter, and patient health status.
  
  
  OBJECTIVE
  To assess if favorable (superficial, nodular, adenoid and trabecular) and unfavorable (infiltrative, morpheaform, micronodular, metatypical, basosquamous) histopathological subtypes of BCC do correlate with anatomic location on the face (facial high risk versus non-high risk zones).
  
  
  METHODS
  Histopathological specimens of all facial BCCs, which were histopathologically diagnosed in the Pathology Department of Şişli Etfal Training Hospital, between the years 2008 and 2014 were retrospectively studied. Histopathological aggressive and non-aggressive subtypes as well as the presence of ulceration were correlated with facial high-risk (i.e. H-zone) and low risk anatomical locations.
  
  
  RESULTS
  Of 184 BCC of unfavorable subtypes, 101 cases were identified in facial high-risk anatomical region (H-zone) compared to 83 cases at non H-zone (P = 0.553). On the other hand the ulceration rate was significantly higher for unfavorable histological subtypes than in the favorable histopathological subtype group (P = 0.042). Regarding anatomic site, ulceration frequency was not significantly different for the H-versus non-high risk zones (P = 0.335).
  
  
  CONCLUSIONS
  A correlation of unfavorable histopathological subtype of BCC and high-risk anatomical location (i.e. H-zone) was not observed in our study. Our results however confirmed a significantly higher rate of ulceration in the subgroup of aggressive histopathological BCC forms. Thus, factors other than histopathological subtype (such as narrow excision margin related to difficult surgical technique in H-zone, microcirculation, vasculature and host inflammatory response) may be responsible for the high recurrence rate in facial H-zone-located BCCs.
authors.affiliation: Department of Pathology, Sisli Etfal Training and Research Hospital Istanbul, Turkey.
authors.forename: Ozben
authors.initials: O
authors.lastname: Yalcin
authors.affiliation: Department of Dermatology, School of Medicine, Acibadem University Istanbul, Turkey.
authors.forename: Engin
authors.initials: E
authors.lastname: Sezer
authors.affiliation: Department of Pathology, Sisli Etfal Training and Research Hospital Istanbul, Turkey.
authors.forename: Fevziye
authors.initials: F
authors.lastname: Kabukcuoglu
authors.affiliation: Department of Pathology, Sisli Etfal Training and Research Hospital Istanbul, Turkey.
authors.forename: Ayse Irem
authors.initials: AI
authors.lastname: Kilic
authors.affiliation: Department of Pathology, Sisli Etfal Training and Research Hospital Istanbul, Turkey.
authors.forename: Ahu Gulcin
authors.initials: AG
authors.lastname: Sari
authors.affiliation: Department of Dermatology, Sisli Etfal Training and Research Hospital Istanbul, Turkey.
authors.forename: Asli Aksu
authors.initials: AA
authors.lastname: Cerman
authors.affiliation: Department of Dermatology, Sisli Etfal Training and Research Hospital Istanbul, Turkey.
authors.forename: Ilknur Kivanc
authors.initials: IK
authors.lastname: Altunay
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002280:Basal Cell Carcinoma / Q000473:pathology*; D005153:Facial Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012878:Skin Neoplasms / Q000473:pathology*; D012883:Skin Ulcer / Q000473:pathology*; D014421:Turkey
keywords: Ulcer; facial BCC
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