INNOVATIONS IN DERMATOLOGIC SURGERY AND MELANOMA PATHOGENESIS: FROM THE PERSONALISED SURGERY TO THE CONCEPT OF GENOMIC MAPPING/TARGETING VIA NITROSAMINES IN DRUGS: SPOTLIGHT ON CONTAMINATION OF ANGIOTENSIN CONVERTING ENZYME INHIBITORS AND ANGIOTENSIN RECEPTOR BLOCKERS.

Abstract

The pathogenesis and successful surgical treatment of cutaneous melanoma remain a mystery to this day, the unraveling of which has excited clinicians and research teams worldwide. The breakthrough regarding the interpretation of the pathogenesis of skin cancer and melanoma in particular in all likelihood concerns phototoxicity and photocarcinogenesis as some of the major factors associated with its occurrence. Extremely interesting and revealing are two types of observations/indisputable facts that definitely change completely the current vision of melanoma occurrence and progression: 1) The presence of carcinogens, photocarcinogens and mutagens in more than 95% of the most widely distributed drugs worldwide. On the one hand, they are inducers of heterogeneous types of mutations and, on the other hand, potentiate phototoxicity, and 2) clinicopathological correlations demonstrating a pathogenetic link between the intake of actual/potential photocarcinogen/mutagen contaminated products and the subsequent or concurrent development of melanomas. The categorical refusal of regulators (so far) to oblige manufacturers to officially declare the presence of photocarcinogens/mutagens/genome modifiers in medicines , remains puzzling and disturbing to say the least. This is what makes it difficult to make an accurate judgement on the specific risk of a particular nitrosamine present as a contaminant in a particular drug in a particular geographical area. The regulation of the distribution and concealment of carcinogens in medicines correlates with the occurrence of heterogeneous forms of it in the geographical regions concerned. This is a strong reason to formalize carcinogens in medicines. Conflicting evidence on the risk of developing melanomas in one latitude/continent or another is likely to correlate with the type of photo/nitroso/contaminant involved and the concentration in which it is present in a given drug. The official data of the regulatory authorities in America and Australia, for example, do not correspond with each other and show the different availability in different preparations with different photocarcinogens/mutagens/genome modifiers or so-called nitrosamines. For other continents, there are no epidemiological data on the subject. It remains an open and speculative question whether genetic targeting based on so-called genetic mapping is involved in these cases in order to maximize future benefits. The issue of genetic profiling of a nation, a geographical region or a particular collective is a matter of national but also global security for every country. In recent times, it is precisely this 'policy of nation preservation' that has led to a ban on the use of US genetic databases, with the 2024 ban targeting the world's strongest export economies: that of China. We present a patient, who developed thick nodular melanoma within a long-term treatment with sartan/valsartan and ACE inhibitor/ Enalapril. We comment on the possibility of a personalized one-stage surgical management of cutaneous melanomas as well as aspects of a new medical concept introduced in the literature; also known as drug-induced Photo Nitroso carcinogenesis/ oncopharmacogenesis of cancer.