Immunohistochemical nuclear staining for p53, PCNA, and Ki-67 in different histologic variants of basal cell carcinoma

Abstract

Background: Increased expression of p53 has been found in the majority of basal cell carcinomas (BCCs); however, UV-light–induced signature mutations are present in only about 50% of cases. Increased nuclear staining with an immunohistochemical marker of proliferation, proliferating cell nuclear antigen (PCNA), has been correlated with aggressive behavior in BCC. Objective: Our purpose was to determine whether there is any relationship between different histologic variants of BCC and their expression of p53, PCNA, and Ki-67. Methods: We used immunohistochemical stains for p53, PCNA, and Ki-67, in superficial-multicentric, nodular-noduloulcerative, sclerosing, infiltrative, and metatypical BCC, to determine whether the staining patterns differ in these different histologic variants of BCC. Results: Superficial-multicentric BCCs were negative for p53 in four of eight tumors. Nodular BCC showed moderately intense p53 nuclear staining with some peripheral accentuation. PCNA nuclear staining was greater than Ki-67, and PCNA-positive cells were fewer than 10% in nodular BCC. Sclerosing and infiltrative BCC showed intense p53 nuclear staining with peripheral accentuation. PCNA nuclear staining was greater than Ki-67, and PCNA-positive cells were greater than 30% in the majority of these tumors. Metatypical BCCs showed diffuse intense p53 staining. PCNA nuclear staining was greater than Ki-67, and PCNA-positive cells were greater than 30% in all tumors studied. When overlying actinic keratoses showed p53 staining, the staining did not necessarily correlate with the intensity or even the presence of positive staining in the subjacent BCC. Conclusion: There are at least four distinctive patterns for staining of p53, PCNA, and Ki-67 that correlate with different histologic variants of BCC. (J Am Acad Dermatol 1997;37:430-7.)