Melolabial Advancement Flap for High-Risk BCC Near the Medial Eye Angle: Phototoxicity/ Photocarcinogenicity Triggered by Nitrosamines in the Polymedication as the Main Cause of Keratinocyte Cancer Development and Progression

The enigma that lies behind the concept of drug-mediated phototoxicity/ – carcinogenicity remains exciting, as well as not fully elucidated. Nitrosamines remain one of the few reasonable, according to a number of authors, even the only currently directly responsible explanation for this mystery. The phototoxicity of most of the nitrosamines is a known nonspecific characteristic of them, established as far back as 1972, but also confirmed recently in the scientific literature: phototoxic and genotoxic nitrosamines are present and distributed in medicines worldwide and as of 2024 (nitrosomorpholine in molsidomine for example). This fact could also be seen as largely determining/structurally defining the global incidence of skin cancer, especially in the context of polymedication and polycontamination (with phototoxic/genotoxic mutagens). Hand in hand with UV radiation, these contaminants also lead to overlapping mutations (RAS/p53), which is a good indication of their possible synergistic action in relation to the potentiation of skin carcinogenesis. Nitrosamines and solar radiation are among the factors that have been identified as the initiating phase of carcinogenesis, mainly affecting cutaneous tumours. This is why the polypharmacy could also be considered a determinant of the incidence of cancer-based on permissive regimens for photocarcinogens in drugs. On this occasion, we report on another patient taking 3 heterogeneous classes of drug preparations, two of them catalogued as potentially contaminated in the FDA list of 2024 for carcinogens/nitrosamines: 1) bisoprolol and propafenone, and the 3rd drug: rosuvastatin. The last one is available as nitroso-rosuvastatin but is not catalogued by the regulators in their lists for preparations containing nitroso compounds with defined actual/potential carcinogenic potency. Dermatosurgical management in the form of a melolabial advancement flap was performed, and an optimal aesthetic result was achieved.