Expression of Cyclooxygenase-2 and Smooth Muscle Actin Biomarkers in Different Subtypes of Basal Cell Carcinoma

Kosar Aghajani Ilanlou¹Roham Sarmadian²Sepideh Hadimaleki³Amir Vahedi³Fariba Heidari⁴Bahare Mehramouz^3*

• ¹Department of Pathology, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran, Tabriz, Iran
• ²Infectious disease research center, Arak University of Medical Sciences, Arak, Iran, Arak, Iran
• ³Department of Pathology, Tabriz University of Medical Sciences, Tabriz, Iran., Tabriz, Iran
• ⁴Department of Community and Family Medicine, Faculty of Medicine,TabrizUniversity of Medical Sciences, Tabriz, Iran

Introduction: Basal cell carcinoma (BCC) is the most common form of skin cancer, with diverse subtypes and UV radiation as a major risk factor. Key markers like COX-2 and smooth muscle actin (SMA) are linked to tumor invasion. This study investigates their expression to improve understanding of BCC progression and treatment.This invitro experimental study investigated COX-2 and SMA expression in BCC subtypes from 51 paraffin-embedded tissue samples. Immunohistochemistry was performed on solid, cystic, infiltrative, adenoid, keratotic, superficial and morphea form BCCs, analyzing clinical and histological factors. Excision margin status and perineural invasion were also evaluated for their potential prognostic significance. Statistical analysis assessed marker expression and subtype relationships, considering confounding variables like the age and gender of the patients.The study evaluated clinical and histological characteristics of basal cell BCC in 51 patients (mean age 64.12±11.45 years, 66.7% male). Nodular BCC was the most common subtype (19.6%). SMA expression was observed in 88.2% of cases and COX-2 in 21.6%. COX-2 expression significantly correlated with invasion depth (p=0.001) and recurrence (p=0.007), highlighting its potential as a prognostic marker. Perineural invasion was detected in 5.9% of cases but did not show a significant correlation with invasion depth (p=0.937) or tumor subtype (p=0.790). No significant associations were found between protein expression and gender or lesion location. These findings support targeted diagnostic strategies. No statistically significant correlation between COX2+ staining intensity and the variables assessed, including depth of invasion, recurrence, gender, site of involvement, and tumor subtype.COX-2 expression significantly correlated with tumor invasion depth and recurrence in BCC, highlighting its potential as a prognostic marker and therapeutic target, while SMA showed limited relevance to tumor behavior. Although excision margin size did not show a statistically significant correlation with recurrence (p=0.371), tumors with margins >0.5 cm exhibited a lower recurrence rate (11.4%), suggesting a possible impact on treatment outcomes.