Relationship between androgen receptor and epidermal growth factor receptor determines aggressive behavior of cutaneous basal cell carcinoma.

ObjectiveCutaneous basal cell carcinoma (BCC) exhibits numerous variants, ranging from non-aggressive to aggressive behavior. Androgen receptor (AR) and epidermal growth factor receptor (EGFR) are both expressed by BCC. This study aims to analyze the differences between aggressive and non-aggressive variants concerning AR and EGFR expression, as well as their relationship with each other.MethodsBetween 2019 and 2024, we analyzed all archival tissue blocks of patients with a diagnosis of BCC who underwent excision. Fifty-three cases with a diagnosis of superficial, nodular, infiltrative, and micronodular BCC were included in the study. Histologically, the infiltrative and micronodular variants were classified as highly aggressive; nodular and superficial variants less aggressive. These characteristics were compared with other features with respect to their statistical significance.ResultWe found a statistically significant relationship between AR, EGFR expression, and tumor variants. While the AR expression was high in superficial and nodular variants, it was weak in the infiltrative type. Whereas the EGFR expression, contrary to AR, was strong in infiltrative and micronodular variants, it was weak in nodular and superficial variants. There was a statistically significant reverse correlation between AR and EGFR (p = 0.005).ConclusionsThe AR expression in BCC is consistent with low-degree malignancy; conversely, EGFR expression is consistent with aggressiveness. We hope our findings lead to further discoveries in employing topical agents that activate AR, next to anti-EGFR agents. Our study is the first and only one that investigated BCC concerning morphological variants and their relationship with AR and EGFR.