MULTIPLE MUSHROOM-LIKE GROWING CYLINDROMAS OF THE SCALP (TURBAN TUMOR) IN A PATIENT WITH BROOKE-SPIEGLER SYNDROME: UNIQUE MANIFESTATION IN A BULGARIAN PATIENT.

Cutaneous cylindromas are rare, slow-growing adnexal tumors commonly found on the capillitium or face. When located on the capillitium, they can cluster together, forming a headgear-like structure that gives the characteristic "turban" appearance. Brooke-Spiegler syndrome, an autosomal dominant condition, is typically benign, though malignant transformation can occur.

DERMATOFIBROSARCOMA PROTUBERANS: WIDE LOCAL EXCISION AS DERMATOSURGICAL APPROACH WITH FAVOURABLE FINAL OUTCOME-CASE PRESENTATION AND SHORT UPDATE ON THERAPEUTIC OPTIONS.

Dermatofibrosarcoma protuberans (DFSP) is a rare, low-grade cutaneous sarcoma typically found on the proximal extremities and the trunk, characterized by infiltrative growth and low risk of metastasis. High rates of local recurrence or relatively large tumor sizes can significantly complicate therapeutic management, particularly when 1) surgical intervention is not adequately performed and /or 2 access to newer medications is limited or their high cost imposes a financial burden on patients. We present the case of a 63-year-old male with a histologically confirmed dermatofibrosarcoma protuberans, measuring 6 cm in diameter, located on the right dorsal region, accompanied by several confluent multifocal nodules situated infralaterally to the primary formation.

DERMATOLOGIC SURGERY: ROTATION ADVANCEMENT FLAP AS FIRST LINE TREATMENT FOR HIGH-RISK SQUAMOUS CELL CARCINOMAS OF THE PERIOCULAR/PERIORBITAL ZONE- PRESENTATION AND DISCUSSION ABOUT 2 NEW CASES.

Rotation advancement flaps are a challenge for dermatosurgery and in particular the severe clinical cases, mainly affecting skin tumors in the facial area or the so-called ˝high risk areas˝. The proximity of these areas to important vital structures (such as nerves and blood vessels) also determines the need for more precision when performing this type of manipulation. Teamwork and preoperative planning are crucial and provide a number of advantages in terms of the timely achievement of the therapeutic endpoints.

SHARK PEDICLE ISLAND FLAP FOR BASAL CELL CARCINOMA OF THE PERIALAR ZONE OF THE NOSE: PHOTOXICITY AND PHOTOCARCINOGENICITY MEDIATED BY POTENTIALLY NITROSAMINE CONTAMINATED DRUG INTAKE -A NEW EXPLANATION FOR THE SKIN CANCERS PATHOGENESIS?

Modern skin cancer pathogenesis includes new concepts such as nitroso photocarcinogenesis and nitroso-mediated photosensitivity. The above 2 new concepts are in all likelihood also modeled/determined by photocarcinogens known as nitrosamines and/or NDSRIs available as contaminants in many drugs worldwide. The phototoxicity of nitrosamines is a known nonspecific property of them, for which evidence exists as far back as 1972.

(NDMA) METFORMIN AND (NTTP) SITAGLIPTIN INDUCED CUTANEOUS MELANOMAS: LINKS TO NITROSOGENESIS, NITROSO-PHOTOCARCINOGENESIS, ONCOPHARMACOGENESIS AND THE METABOLIC REPROGRAMMING.

Changing the vision, understanding, interpretation and analysis of certain data or scientific dilemmas is what is able to change the status quo and revitalize a mission, an impulse or important thoughts, thus creating the conditions for it to increase immensely the chances of bringing it to success. Or, following Albert Einstein's postulate: ˝We cannot solve our problems with the same thinking we used when we created them˝, we should think: ˝Where does the road to success start? How do we solve or neutralize a problem? ˝ And the answer is: ˝ By taking a consistent and systematic approach, analyzing each component! And we eliminate every possibility of negative influence.˝ These thoughts apply with full force to cancer rates in general, but also to melanoma rates in particular: the murderous tempo of globalization and modernization in medicine has not yet led to the desired decrease in these rates; on the contrary, they are rising headlong and remain largely unpredictable and difficult to regulate.

EDUCATION FROM DERMATOLOGISTS: THE SIMULTANEOUSLY DEVELOPMENT OF 16 KERATINOCYTIC CANCERS AFTER USE OF METFORMIN IN COMBINATION WITH LOSARTAN/ HYDROCHLOROTHIAZIDE, METOPROLOL AND NIFEDIPINE- IMPORTANT LINKS TO DRUG RELATED (PHOTO)-NITROSO-CARCINOGENESIS AND ONCOPHARMACOGENESIS.

Oncopharmacogenesis and Drug-Induced Skin cancer related Nitrosogenesis are newly introduced concepts in the medical literature that owe their genesis or presence to the carcinogens/ mutagens, also known as nitrosamines/NDSRIs, which are present in a heterogeneous class of drugs. The contribution to the origin of these 2 concepts is entirely due to 1) the functions and efficacy of FDA in terms of control and identification of these carcinogens, and 2) the establishment of clinicopathological correlations by the dermatologists, occurring during drug intake. According to recent FDA data, the concentration of NDMA in just one metformin tablet could be up to more than 5-fold increased.

PERIOCULAR HIGH RISK BCCS AFTER ADDITIONAL/PARALLEL INTAKE OF TORASEMIDE, MOXONIDINE AND MIRABEGRON: IMPORTANT LINKS TO SKIN CANCER RELATED (PHOTO-) NITROSOGENESIS IN THE CONTEXT OF PHARMACO-ONCOGENESIS.

The Nitrosogenesis of skin cancer is a modern newly introduced concept in medicine, mainly concerning melanoma, but also keratinocytic cancers such as basal cell carcinoma. The nitroso-contamination of more than 300 drugs worldwide and the permanent (relatively short-term) intake of mutagen-contaminated drugs could create serious prerequisites for the development of skin cancer. Retrospective but also prospective analyses following potentially contaminated polymedication with a heterogeneous type of nitrosamines in real patients are indicative of a causal connection rather than a sporadic association between 1) intake of a possibly nitrosamine-contaminated drug and 2) generation of keratinocytic skin cancer.

(N-NITROSO) PROPAFENONE INDUCED ADVANCED NODULAR MELANOMA-FIRST REPORTED CASE IN THE WORLD LITERATURE: THE INEXTRICABLE LINKS BETWEEN THE PHOTOCARCINOGENESIS, DRUG RELATED NITROSOGENESIS AND PHARMACO-ONCOGENESIS.

Onco-pharmacogenesis or pharmaco-oncogenesis of skin cancer is a concept , which could also be considered as an "end product" of drug-mediated Nitrosogenesis or of the permissive regime for carcinogens to be (un)controlled released in drugs. Their controlled distribution remains until 2025 as a forced and non-alternative and there is no indication of any possibility to introduce a full elimination regime against the already mentioned carcinogenic availability. There are three main worrying facts that determine the need for these elimination regimes: 1) the clinicopathological correlations concerning the intake of a heterogeneous class of drugs and the subsequent development of relatively homogeneous tumours/ such as melanoma, 2) the recently proven mutagenic/ carcinogenic action of certain nitrosamines, but this time directly on human DNA, and 3) the fact that some of the nitrosamines are potent photocarcinogens that exert their genotoxic effects only after irradiation with UVA/ also recently proven/.

DRUG RELATED NITROSOGENESIS, PHOTOCARCINOGENESIS AND ONCOPHARMACOGENESIS OF NODULAR MELANOMA: A CASE RELATED ANALYSIS CONCERNING THE POLYCONTAMINATION OF THE POLYMEDICATION WITH VALSARTAN/HYDROCHLOROTHIAZIDE AND BISOPROLOL.

Despite the fact that the pathogenesis of cutaneous melanoma is shrouded in mystery, factors that have been neglected or unnoticed until now have come to the attention in recent years, and in all likelihood, they could also be pivotal. These factors, known as nitrosamines or NDSRIs, are characterized by high carcinogenic and mutagenic potency, and some of them have demonstrated these properties to human DNA as well. Unfortunately, these ingredients also turn up as contaminants in about 300 of the most widely distributed drugs worldwide.

Fine scalpel surgery: preserving the dartos muscle in a patient with scrotal and perigenital giant Buschke-Löwenstein tumors.

Giant condyloma acuminatum (GCA), alternatively referred to as a Buschke-Löwenstein tumor (BLT), is an uncommon, benign, but locally aggressive form of verrucous carcinoma. The condition usually affects the male population under the age of 50 years; however, there have been rare reports of pediatric cases. Various risk factors such as smoking, diabetes, promiscuous behavior, poor hygiene, immunosuppression, and others are linked to the development of this condition.

MULTIPLE KERATINOCYTIC CANCERS AFTER ENALAPRIL/LOSARTAN INTAKE: POTENTIAL LINKS TO DRUG MEDIATED NITROSOGENESIS/CARCINOGENESIS: MELOLABIAL ADVANCED FLAP AND UNDERMINING SURGERY AS OPTIMAL THERAPEUTIC APPROACH.

According to scientific databases, nitrosogenesis and carcinogenesis have been inextricably linked for decades and are undoubtedly one of the most serious causes of cancer induction (not only skin cancer) known to humankind.Some of the most potent modifiers of human DNA turn out to be numerous, known since the last century, difficult to classify as carcinogenic potency, yet available for decades as additional, unregulated, often undisclosed ingredients in about (currently) 300 drugs used by at least 5 billion patients worldwide. While this may sound ridiculous, this information turns out to be reality.

METASTATIC NODULAR MELANOMA DEVELOPING ON NEVUS SPILUS DURING INTAKE OF BETA BLOCKERS (BISOPROLOL/NEBIVOLOL) AND ACE INHIBITORS (PERINDOPRIL). POTENTIAL LINKS TО THE DRUG RELATED NITROSOGENESIS/CARCINOGENESIS, DUNNING-KRUGER EFFECT AND GENETIC WEAPONS OF THE NEW GENERATION.

Drug-induced Nitrosogenesis/Carcinogenesis turns out to be a ubiquitous, pervasive, large-scale, poorly controllable concept for the academic community, which underlies the long-term, permanent modification of the human genome by contact with nitrosamines/NDSRIs, which ultimately leads to the generation of diverse cancers, but also melanoma in particular. The discovery of a (currently) unclassifiable number of nitroso derivatives/genome modifiers in the most commonly distributed drugs worldwide (in about 300 preparations according to the FDA/includes beta blockers/bisoprolol/nebivolol and ACE inhibitors/perindopril), their forced tolerability, attributed as a necessity or lack of alternative also to the present (but also to future periods), and their proven carcinogenicity (already 70 years ago), suggest a kind of creepy form of experiment to which public health is subjected worldwide. The creation of a universal nitroso-comfort of pharmaceutical companies and the regulation of a permanent intake of carcinogens in drugs for years to come, but also decades back, suggest possible cartel agreements between the regulation/distribution unit and that of production cycles.

NITROSAMINE CONTAMINATION WITHIN CARDIAC MULTIMEDICATION - SARTANS (VALSARTAN), CALCIUM CHANNEL BLOCKERS (AMLODIPINE AND NIFEDIPINE), AND ANTIARRHYTHMICS (PROPAFENONE) AS A SIGNIFICANT FACTOR IN THE DEVELOPMENT AND PROGRESSION OF MULTIPLE KERATINOCYTIC CANCERS: ADVANCEMENT ROTATION FLAP FOR KERATOACANTHOMA OF THE UPPER LIP AND UNDERMINING SURGERY FOR BCC OF THE SHOULDER AS AN OPTIMAL DERMATOSURGICAL APPROACH.

The data on the polycontamination of multimedication in polymorbid patients with a heterogeneous class of carcinogens/nitrosamines, NDSRIs (classified according to the FDA regulation to the companies of 2023 to those with a carcinogenic potency between 1 and 5), are one of the most important steps to clarify the concept of skin cancer nitrosogenesis/ pathogenesis. The FDA is the first regulatory institution in the world to courageously declare that a problem exists and should be addressed. The main and currently unexplained and somewhat controversial issue lies in 1) the sporadic nature of polycontamination in different geographical regions, and 2) the lack of official data from the established international, but also regional pharmaceutical market regulators on the results of the checks conducted for nitrosamine contamination of the respective batches.

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.

NITROSOGENESIS LESSONS FROM DERMATOLOGISTS-NITROSAMINES/ NDSRIS CONTAMINATION OF THE POLIMEDICATION IN POLIMORBID PATIENTS AS THE MOST POWERFUL SKIN CANCER INDUCTOR: DOUBLE HATCHET FLAP FOR SCC OF THE SCALP OCCURRING DURING TREATMENT WITH VALSARTAN/ HYDROCHLOROTHIAZIDE AND LERCANIDIPINE.

Nitrosogenesis remains to be a topic that is and, in all likelihood, will be relevant in the near and distant future. The reason for this actuality is mainly due to the official data of the regulatory authorities in the face of the FDA, starting back in 2018 with the announcement of the contamination of Valsartan with nitrosamines. This issue only became more profound in April 2023, when again the FDA declared over 250 of the most widely distributed drugs worldwide as actually or potentially contaminated with ˝hypothetical˝ carcinogens.

NITROSOGENESIS, ANTIDEPRESSANTS AND THE SERTRALIN INDUCED NEVUS ASSOCIATED CUTANEOUS MELANOMA: THE NDMA/ NNK (NDSRIS) CONTAMINATION AS MOST POTENT MELANOMA INDUCTORS: ALEA IACTA EST.

The purposeful oblivion of the objective truth, the disregard of scientific reality, the denial of the contributions and successes of surrounding researchers, the substitution of priorities in clinical routine and the unwillingness to reason in the right direction often lead to disastrous consequences in the field of public health. Controlled projects almost never lead to a significant contribution or breakthrough in medicine that will be remembered by future generations. Another illustrative example in this regard is the link shared above to the saga of the worldwide cancer pandemic and its possible real cause: the contamination of drugs with nitrosamines/NDSRIs.

MORPHEAFORM BCC OF ALA NASI: A SUCCESSFUL DERMATOSURGICAL APPROACH BY TRANSPOSITION FLAP FROM THE ADJACENT AREA. CONTAMINATION OF VENLAFAXINE, BISOPROLOL AND OLANZAPINE WITH NITROSAMINES/NDSRIS: THE MOST LIKELY CAUSE OF SKIN CANCER DEVELOPMENT AND PROGRESSION.

Two steps are able to lead to a significant decrease in the incidence of skin cancer overall and/or to its parallel and successful surgical treatment. The first step concerns its non-occurrence or less frequent clinical manifestation and is largely related to the modern concept known as prevention, but not the one mainly related to solar radiation, but: 1) informing patients about the possible contamination of certain drugs with carcinogens/nitrosamines/NDSRIs and 2) making clinicians aware of the modern concept of limited to completely eliminated intake of nitrosamines/NDSRIs in medications. The ineffectiveness of either of these entities could in all likelihood be seen as one of the major causes of the headline growth in the incidence of skin cancer and keratinocytic cancer in particular.

Giant basal cell carcinoma of the scalp: rotation advancement flap as a successful dermatosurgical approach.

Giant keratinocyte tumors, in particular basal cell carcinomas of the scalp area, are a serious challenge for dermatosurgeons, oncologists, and maxillofacial and reconstructive surgeons. The scalp area is limited in terms of skin mobility, and its elasticity decreases with age. The size of the tumors in this area and the degree of infiltration of the underlying tissues are important for the therapeutic choice, from surgical removal, waiting for granulations to form, and placing a split skin mesh graft (at a later stage) to performing complex rotational/transpositional or advancement flaps.