NITROSAMINES IN COMMONLY PRESCRIBED ANTIHYPERTENSIVES AND THE (UN)CONTROLLED DRUG-INDUCED SKIN CANCER: SIMULTANEOUS DEVELOPMENT OF CUTANEOUS MELANOMA AND MULTIPLE BCC AFTER CONCOMITANT ADMINISTRATION OF BISOPROLOL AND FUROSEMIDE.

The era of nitrosogenesis is the era that is conditioned by the permanent and prolonged intake of carcinogens/mutagens, also known as nitrosamines/NDSRIs in the context of polymedication/polycontamination in polymorbid patients. Until recently, the favoured and universally accepted thesis by the scientific community that polymorbidity determines the risk of developing cancer has been shown to be weakly substantiated and superseded by the more modern notion that: it is the polycontamination with carcinogens in the context of concomitant medication/ polymorbidity that determines to a large extent the risk of developing heterogeneous cancers, including skin cancer: keratinocytic and melanocytic. The FDA is the organization that first pulled back the curtain on the backstage back in 2018 on this topic. It was not until 2023 that the FDA again catalogued over 250 drugs that are affected by contamination with carcinogens/mutagens/NDSRIs having varying carcinogenic potencies graded between 1 to 5. The expectations of clinicians and patients globally at the moment remain hopeful that the diplomatic recommendations of regulators will soon be replaced by more restrictive regimes and sanctions. The reason for the need to clarify this issue quickly is due to the following circumstances: 1) The reassuring calls and analyses of the regulators that the minimum intake of carcinogens ( nitrosamines or intake within reference values) , could not become a threat to the health of patients even after 70 years of intake, appear to be rather inconsistent; 2) Lack of any official data on any drug batch that has at least been declared by the FDA/EMA (if declared at all) as potentially contaminated; 3) Another not insignificant reason is that a number of scientific publications are indicative of exactly the opposite: short-term concomitant intake of polycontaminated drugs leads to short-term cancer development while shortening cumulative survival and quality of life for those affected. Only the transparency of the results of checks carried out on the presence of carcinogens in drug batches can guarantee peace of mind, and this in turn can be guaranteed by the regulatory authorities. 4) In parallel, the number of clinical data indicating an association between the intake of potentially nitrosamine-contaminated drugs (mainly for high blood pressure, but not only) and - in particular - keratinocytic and/or melanocytic skin cancer is growing avalanche-like. The dramatic increase in skin cancer in general/ worldwide is in absolute contradiction to the continuous explanations that the most important factor in the generation of skin cancer is ultraviolet light and sunburn: the incidence of skin cancer is increasing despite the widespread intensive use of sunscreen protection creams, the lack of any sun exposure in certain groups of patients, and its occurrence in areas not exposed to solar radiation. It follows only that solar radiation is not the only and perhaps not the most important factor determining the occurrence and progression of skin cancer. We report another concomitant intake of potentially nitrosamine contaminated blood pressure medications: bisoprolol and furosemide, taken over a period of 7 years that resulted in the concurrent occurrence of a medium-thickness cutaneous melanoma and 2 basal cell carcinomas. Successful surgical treatment of the tumors was performed, and the role of concurrent administration of ˝hypothetical˝ class 4 carcinogens within the framework of polymedication, polycontamination, and polymorbidity is discussed.