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Publisher: Peytchinski Publishing Ltd.
ISSN: 1312-773X (Online)
Issue: 2026, vol. 32, issue2
Subject Area: Medicine
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DOI: 10.5272/jimab.2026322.6860
Published online: 18 May 2026
Original article
J of IMAB. 2026 Apr-Jun;32(2):6860-6866
COMPARISON OF EZH2, BCL-2, BER-EP4, AND CK20 EXPRESSION WITH THE KI67 PROLIFERATIVE INDEX AND OTHER ADVERSE CLINICAL INDICATORS, AND COMPARISON OF EXPRESSION WITH THE MORPHOLOGICAL TYPE OF BASAL CELL CARCINOMA
Boyana Anatolieva1
, Ivan Ivanov2, Klimentina Gospodinova1,
1) Department of Dermatology, Venereology and Allergology, Medical University, Pleven, Bulgaria.
2) Department of Pathology, Medical University, Pleven, Bulgaria.
ABSTRACT:
Introduction: Basal cell carcinoma (BCC) is the most common cutaneous malignant tumor, characterized by locally invasive growth and low metastatic potential. The role of immunohistochemical markers such as EZH2, Bcl-2, Ber-EP4, and Ki67 in the assessment of tumor biology is not sufficiently understood.
Purpose: To investigate the expression of EZH2, Bcl-2, Ber-EP4, and Ki67 in basal cell carcinoma verified with CK20, and to analyze their relationship with proliferative activity and some clinical parameters.
Materials and methods: A cross-sectional study was conducted on 50 histologically confirmed BCCs for the period 2023–2024. Immunohistochemical staining for EZH2, Bcl-2, Ber-EP4, Ki67, and CK20 was performed. Their expression was assessed semiquantitatively by staining index (SI), and Ki67 as a percentage of positive cells. The χ² test, ANOVA, and Kruskal-Wallis test were used at a significance level of p<0.05.
Results: All tumors were CK20-negative. A statistically significant inverse relationship was found between EZH2 and Ki67 expression (p=0.036), with higher EZH2 expression being associated with a lower proliferative index. No statistically significant relationship was found between Ki67 and Bcl-2 or Ber-EP4. A significant association was found between Bcl-2 expression and tumor size (p=0.037), with smaller tumors showing higher expression. No correlation was observed between co-expression of markers and gender, localization, or combined immunoprofiles.
Conclusion: EZH2 demonstrated an inverse relationship with proliferative activity in BCC, which probably reflects methodological peculiarities in the assessment. Bcl-2 may have a role in the early stages of tumor development. Further studies are needed to clarify the prognostic value of these markers.
Keywords: Basal cell carcinoma, Cytokeratin 20, EZH2, Bcl-2, Ber-EP4, Ki67, immunohistochemistry,
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Please cite this article as: Anatolieva B, Ivanov I, Gospodinova K. Comparison of EZH2, Bcl-2, Ber-EP4, and CK20 expression with the Ki67 proliferative index and other adverse clinical indicators, and comparison of expression with the morphological type of basal cell carcinoma. J of IMAB. 2026 Apr-Jun;32(2):6860-6866. [Crossref - 10.5272/jimab.2026322.6860]
Correspondence to: Boyana Anatolieva, MD, PhD, Department of Dermatology, Venereology and Allergology, Medical University of Pleven; 1, St. Kliment Ohridski Str., Pleven, Bulgaria E-mail: b.todorova77@gmail.com
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Received: 28 October 2025
Published online: 18 May 2026