Abstract
Introduction: Contamination of drugs for high blood pressure (sartans/ angiotensin receptor blockers) with nitrosamines occurs during the manufacturing process and has proven to be a serious international health problem. The reason for this problem is that the 4 nitrosamines discovered so far have been associated with the simultaneous or gradual development of cutaneous tumors as well as tumors of other organ systems. The presence of angiotensin receptors in melanocytic and keratinocytic tumors and their metastases adds difficulty when attempting to determine the relative importance of each of these two components (i.e. nitrosamines and angiotensin receptors) in the context of carcinogenesis. Case report: We report a 40-year-old patient with arterial hypertension with a duration of skin complaints of about 7 months, clinically manifested by 1) the appearance of a solitary tumor near the medial corner of the left eye, verified histologically as Basal Cell Carcinoma (BCC), and 2) multiple, eruptive dysplastic nevi in the area of the posterior sweat gutter. The patient’s systemic medications included: bisoprolol 5mg (1-0-1 / 2) and indapamide 1.5mg (1-0- 0), taken for one year, and 2 years of treatment with amlodipine / valsartan - 5 mg / 160 mg (1-0-1/2) for an initial period of 1 year, followed by a reduced dose of (1/2-0-0) for an additional year. Conclusion: We report the simultaneous development of basal cell carcinoma and dysplastic nevi after the use of a preparation containing generic valsartan. We discuss 1) the role of nitrosamines as possible major factors in the development of dysplastic nevi and BCC; 2) the possible effect of sartans themselves on angiotensin receptors in the skin and: 3) a new, innovative scheme for treatment of drug-induced BCC by cryoimmunotherapy. Keywords Nitrosamines; Valsartan; Angiotensin Receptor Blockers; Arterial Hypertension; Melanoma; BCC; Cryoimmunotherapy
Highlights
Contamination of drugs for high blood pressure with nitrosamines occurs during the manufacturing process and has proven to be a serious international health problem
We report the simultaneous development of basal cell carcinoma and dysplastic nevi after the use of a preparation containing generic valsartan
This seemingly trivial case is interesting from 3 main points of view: 1) Innovative treatment of high-risk non-melanocytic skin tumors with a new treatment regimen, 2) drug mediated carcinogenesis - in this case the drug valsartan, which could be considered as a possible pathogenetic trigger for generating melanocytic and non-melanocytic skin tumors and 3) the most important one about the possible role of nitrosamines as triggers of malignant skin tumors
Summary
We have presented a rare case of a possible drug-induced high-risk epithelial tumor - basal cell carcinoma - near the eye, occurring in parallel with multiple eruptive, partly dysplastic nevi, following the administration of valsartan. For the first time in the world literature, the possible key role of nitrosamines as inducers of melanoma, melanoma precursors and non-melanocyte skin cancers is discussed. The data analysed in this scientific paper concern drugs that have not been checked as batches by control authorities for the presence or absence of nitrosamines. An innovative, unpublished scheme for the treatment of a nonmelanoma skin tumor by immunocryotherapy has been applied, leading to complete remission
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