Aim: To analyze the expression pattern of several tumour-related markers according to the clinical features of primary and recurrent aggressive-growth basal cell carcinoma (BCC) of the face.

Material and methods: From a group of 369 patients operated between 1997 and 2009 in the Department of Maxillofacial Surgery of the Jagiellonian University in Cracow with facial BCC; the archival tissue samples from 36 patients with aggressive histological BCC subtypes were selected. The specimens were divided into two groups: primary (21 samples) and recurrent (15 samples) tumours and were compared by assessing the expression of E-kadhedrin, Ki-67, alpha-SMA and S100. Results were analyzed according to clinical data.

Results: From 36 patients (9.7%) with aggressive-growth BCC; 15 (42%) patients presented the infiltrating variant of BCC; 14 (39%) patients – the mixed pattern, 6 (17%) patients – the basosquamous type, 1 (2%) patient – the micronodular type. There were no significant differences between groups of primary and secondary tumours in the expression of E-kadhedrin, Ki-67 and alpha-SMA. Both groups also presented comparable clinical course, concerning positive excision margins, recurrence rate, metastases occurrence ( p > 0.05). Perineural invasion (S100) was increased in the primary BCCs compared with recurrent BCCs ( p = 0.006) and was correlated with higher metastases occurrence in primary BCCs ( p = 0.03). Reduced expression of E-cadherin was correlated with higher recurrence rate in primary BCC ( p = 0.04) and higher incidence of positive excision margins in recurrent infiltrating BCC ( p = 0.01).

Conclusions: As there is no significant difference in clinical course between primary and recurrent aggressive histological subtypes of BCC, both groups require comparable wide excision. The results of this study suggest that assessment of perineural invasion in primary BCC can be an important prognostic factor for BCC metastases. In addition, reduced expression of E-cadherin may play an important role in evaluation of recurrence risk of high-risk BCCs.