BASAL CELL CARCINOMA: EXPRESSION OF APOPTOSIS SUPPRESSING PROTEIN BCL-2
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Objective: The Bc1-2 protein increases cell longevity by inhibiting apoptosis (programed cell death). The aim of the study is to evaluate the expression and possible role of Bc1-2 in basal cell carcinoma (BCC). Study design: Twenty two patients with 24 lesions (BCCs) were included in the study. After excision with safety margins, routine paraffin section of formalinfixed BCCs were labeled with anti-Bc1-2 monoclonal antibodies using a biotin-aviclin irnmunoperoxidase procedure. Apoptotic cells were counted in ten high power fields (HPFs) of each section. The results were compared with those in ten age and sex matched controls. Results: Excision with reconstructive procedures was done with a safety margin (5mm). Simple undermining and advancement was done in 8 patients. post-auricular fill thickness skin graft in 7 patients, local flaps (V-Y advancement flap, rotation flap) in 9 patients. In normal skin samples, Bc1-2 was only expressed by the basal keratinocytes in one of ten (10%) samples. The mean apoptotic index (Al) was 0.5 cells/JO HPFs. In BCC, BcI-2 was expressed by tumor cells in 21/24 cases (87.5%) with apoptotic index Al ranging between 2-11 cells/JO HPFs with a mean 4.94+1.2 cells (statistically highly sign(Jlcant). Conclusion: BcI-2 over-expression in the majority of BCCs may be the initial factor that predisposes to malignant transformation of keratinocytes by inhibiting apoptosis.