650 Original article doi: 10.1016/S2222-1808(16)61103-9 ©2016 by the Asian Pacific Journal of Tropical Disease. All rights reserved. Mid-face location of primary basal cell carcinoma related to cancer aggressivity Prasetyadi Mawardi 1,2* , Handono Kalim 3,4 , Kusworini Handono Kalim 4,5 , Loeki Enggar Fitri 4,6 , Karyono Mintaroem 4,7 , Ambar Mudigdo 2,8 , Oyong 2,8 , Brian Wasita 2,8 1 Dermatovenereology Department, Medical Faculty, Sebelas Maret University, Surakarta, Central Java, Indonesia 2 Dermatovenereology Department, Moewardi Public Hospital, Surakarta, Central Java, Indonesia 3 Internal Medicine Department, Faculty of Medicine, University of Brawijaya, Malang, East Java, Indonesia 4 Saiful Anwar Public Hospital, Malang, East Java, Indonesia 5 Clinical Pathology Department, Faculty of Medicine, University of Brawijaya, Malang, East Java, Indonesia 6 Parasitology Department, Faculty of Medicine, University of Brawijaya, Malang, East Java, Indonesia 7 Pathology Department, Faculty of Medicine, University of Brawijaya, Malang, East Java, Indonesia. 8 Pathology Department, Medical Faculty, Sebelas Maret University , Surakarta, Central Java, Indonesia Asian Pac J Trop Dis 2016; 6(8): 650-653 Asian Pacific Journal of Tropical Disease journal homepage: www.elsevier.com/locate/apjtd *Corresponding author: Prasetyadi Mawardi, Dermatovenereology Department, Medical Faculty, Sebelas Maret University, Surakarta, Central Java, Indonesia. Tel: + 628164250638 E-mail: prasetyadimawardi@gmail.com The study protocol was performed according to the Helsinki declaration and approved by Medical Faculty, Sebelas Maret University, Surakarta, Central Java, Indonesia. The ethical clearance number: 934/XII/HREC/2015. The journal implements double-blind peer review practiced by specially invited international editorial board members. 1. Introduction Basal cell carcinoma (BCC) is the most common skin tumor in humans[1]. BCC is locally aggressive which may invade the skin and adjacent structure including the muscles and bones and it has the low metastatic potential[2]. The highest incidence of BCC is in Australia with the ratios of 1 041 in 100 000 male population, and 745 in 100 000 female population. The incidence of skin cancer has markedly increased over the past decade. At this time, There are 2 up to 3 million of BBC that are non melanoma skin cancer [3]. In Indonesia, BCC is in the 3rd rank after breast cancer and cervix cancer[4]. In Moewardi Public Hospital, it is the most frequent of the skin cancers[5]. Ultraviolet B ( UV-B, 290–320 nm wavelength) irradiation is a major etiologic and risk environmental factor in the pathogenesis of melanoma and non-melanoma skin cancer, including BCC[6]. Photocarcinogenesis follows a multistage model of cancer development in which UV-induced DNA damage leads to mutations resulting in activation of oncogenes ARTICLE INFO ABSTRACT Objective: To study the aggressiveness of basal cell carcinoma (BCC) on the mid-face location. Methods: A total of 30 patients were diagnosed using specimen biopsy with hematoxylin- eosin stain at Moewardi Public Hospital in Surakarta, Central Java, Indonesia. The age, gender distribution, site of the lesion, as well as clinic-pathological appearance were analyzed. Results: There were 30 patients consisting of 46.7% males and 53.3% females with ages ranging from 33 to 91 years old and with the most common occupation, such as farmers (53.6%) and housewives (26.7%). Morpheaform subtypes BCC were more frequent than other types. Based on the predilection, most of the BCC were found to be in the mid-face (76.7%) and using determined criteria of histopathological examination, the aggressive appearance was 77% and non-aggressive BCC was 23%. The BCC on the mid-face location was more aggressive than the other sites (P < 0.05). Conclusions: BCC is the most common skin tumor in humans with rare metastases, which might cause significant damage due to its local recurrences and aggressiveness. BCC on the mid-face is significantly more aggressive than that on the other predilection sites. Contents lists available at ScienceDirect Article history: Received 7 Jun 2016 Received in revised form 22 Jun, 2nd revised form 27 Jun 2016 Accepted 10 Jul 2016 Available online 15 Jul 2016 Keywords: BCC Mid-face Aggressive Ultraviolet B