Georgi Tchernev, К. Tchernev, Valentina Broshtilova
The surrounding environment is a risk zone that could disrupt tissue homeostasis or tissue integrity, which could have frequent and fatal consequences for the affected organisms. Nitrosamines, as already known photocarcinogens in medicines, are among the substances that, in one form or another, enter the human body and could trigger a cascade of processes leading to probable mutations and skin cancer development and progression. The elimination of these cutaneous tumors is a serious challenge for dermatologic surgeons. We present a case of a primary defect in the right nasal ala, following basal cell carcinoma excision, successfully reconstructed both functionally and aesthetically using dermatologic surgery procedure.The article comments mainly on the possible pathogenetic role of the systemic medication taken by the patient to date, consisting of amlodipine, valsartan, bisoprolol, timolol, clopidogrel, pantoprazole, rosuvastatin, and latanoprost, in relation to the concepts of phototoxicity and photo carcinogenicity. Nitrosamines, as known contaminants in those drugs, are known to be photolabile and, under the influence of solar radiation, undergo photodecomposition and generate nitric oxide. The last one interacts with ROS and regarding the current scientific knowledge is/ could be associated with the subsequent generation of mutations responsible for skin cancer. Drug related Nitroso-Photo Carcinogenesis seems to be an important part of the skin cancers pathogenesis. For this reason, the intake of polymedication, potentially contaminated with nitrosamines or prone to forming them in an acidic/gastric environment, could be considered as extremely problematic in terms of skin cancer generation. At the same time, it should not be overlooked that many types of severe and risky dermatosurgical procedures performed in our patient, but not only, could be probably avoided entirely, given that the cause of skin cancer could be mediated precisely through the exposure of the human organism to known photo-carcinogens or so-called nitrosamines: pro carcinogenic substances also distributed through medicines.