Environmental Carcinogenesis: Nitric Oxide Release after Photodecomposition of Nitrosocontaminants in Drugs (Under UV Exposure) as Substantial Factor for Skin Carcinogenicity. Sertraline Induced Cutaneous Melanoma - Third Reported Case in Scientific Liter

The modern understanding of carcinogenicity has increasingly shifted towards the recognition of the importance of some new triggering factors or factors with exogenous nature. The early and adequate recognition of the environmental carcinogenic acting agents seems to be from paramount importance for their subsequent fast elimination. The regular, permanent intake of nitrosamines in drugs seems to be one of the most serious problems worldwide concerning the problem with the environmental mediated carcinogenicity. The reason for that is that the so called Nitroso compounds seems to be 1) genome modifiers and 2) photocarcinogens. Recent molecular insights suggest that certain nitroso compounds present in widely used medications worldwide may play a more significant role in carcinogenesis than genetic predisposition or other triggering factors alone. There are two main mechanisms that may explain the potential link or axis between the onset of depression and the development and progression of cutaneous melanoma: 1) current concepts of depression pathogenesis define it as an additionally inflammatory disorder characterized by the dysregulation of cellular immunity (immunity, responsible also for protection from cutaneous melanoma) , and 2) the environmental exposure to human photocarcinogens, the so-called nitrosamines, through medications that undergo photodecomposition under ultraviolet light, acting as nitric oxide donors. In this context, we aim to emphasize the potential carcinogenic impact of even a monomedication while integrating the latest emerging evidence. We report the third case report of sertraline-induced cutaneous melanoma in a patient with a diffuse metastatic spread. The concepts of Nitroso-Photocarcinogenesis/ Photo-Nitrosocarcinogenesis - also referred as drug-mediated Nitrosogenesis or Oncopharmacogenesis / Pharmaco- oncogenesis - represent one of the most compelling emerging paradigms in modern medicine, particularly with regard to skin cancer and melanoma pathogenesis.