Telmisartan/hydrochlorothiazide-induced nevus-associated cutaneous melanoma: first report in the medical literature

Tchernev, Georgi; Patterson, James W.

doi:10.1080/17512433.2021.1890581

Cited by 11 publications

(21 citation statements)

References 19 publications

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“…or combination of telmisartan with hydrochlorothiazide have been reported and described in the scientific literature as possible inducers of nevus associated or occult melanomas, most likely due to possible contamination of the batches with nitrosamines [2,3].…”

Section: Telmisartanmentioning

confidence: 99%

Adverse Drug Reactions: Nitrosamine (and/or Telmisartan/HCT) Induced Nevus and Epidermal Scalp Cyst

Oliveira¹,

LJ²,

Tchernev³

2021

CRDOA

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This is a presenting case of a 57-year-old male with a longstanding history of primary arterial hypertension since the age of 13 years. He was placed on a treatment regimen of telmisartan/ hydrochlorothiazide (HTC) 80/12.5 mg oral half tablets daily (1/2-0-0) 10 years ago and has continued with this treatment to this day. The patient recently visited our clinic due to growing concerns of an unclear and at the same time haemorrhagic lesion on the scalp (Figure 1a). According to the anamnestic data, the scalp lesion was thought to appear roughly 9-10 years after starting therapy with telmisartan/HTC and continued to grow in size to about 15x8 mm (Figure 1a)

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Section: Telmisartanmentioning

confidence: 99%

Adverse Drug Reactions: Nitrosamine (and/or Telmisartan/HCT) Induced Nevus and Epidermal Scalp Cyst

Oliveira¹,

LJ²,

Tchernev³

2021

CRDOA

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“…The lack of follow-up evidence to clarify the troubling data shared in 2015/2016 regarding the use of sartans/ angiotensin receptor blockers and the risk of developing various skin tumors is at least concerning [1,4,5]. However, this evidence is probably multifactorial [1,6,7]. The introduction, monitoring and recording of so called "dose-dependent time intervals for generating a neoplastic cell clone" or "for the transformation of an existing normal one into a pathological/ tumor one" are steps in the right direction [7].…”

Section: Introductionmentioning

confidence: 99%

“…The introduction, monitoring and recording of so called "dose-dependent time intervals for generating a neoplastic cell clone" or "for the transformation of an existing normal one into a pathological/ tumor one" are steps in the right direction [7]. The reason is that they show a certain stereotypical clinical behaviour and recurrence of events and processes that can then be further analysed [7]. The stereotypical recurrence is indicative of existing dependencies or potentially causal relationships [7].…”

Section: Introductionmentioning

confidence: 99%

“…The reason is that they show a certain stereotypical clinical behaviour and recurrence of events and processes that can then be further analysed [7]. The stereotypical recurrence is indicative of existing dependencies or potentially causal relationships [7].…”

Section: Introductionmentioning

confidence: 99%

“…Tumor development may be potentiated by: 1) the active ingredient of a particular drug (although unlikely) [8][9][10], in this case the sartan/ angiotensin receptor blocker (due to the established presence of angiotensin receptors in the skin [11]); and 2) contaminants in the form of nitrosamines (four so far, according to official data), causing up to 15 different tumors (very likely) [1,3]. Thus far, the dynamics of development of skin neoplasms (epithelial and melanocytic) show that they could be dose-dependent [1,7] and that they can occur regardless of whether the agents are generics or original sartans [1,7]. This "stereotypical tumor behaviour" has been established in our clinical observations [1,7].…”

Section: Introductionmentioning

confidence: 99%

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Valsartan (or/and Nitrosamine) Induced BCC and Dysplastic Nevi: Current Insights

Tchernev¹,

Junior²,

Kandathil³

et al. 2021

CRDOA

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Introduction: Contamination of drugs for high blood pressure (sartans/ angiotensin receptor blockers) with nitrosamines occurs during the manufacturing process and has proven to be a serious international health problem. The reason for this problem is that the 4 nitrosamines discovered so far have been associated with the simultaneous or gradual development of cutaneous tumors as well as tumors of other organ systems. The presence of angiotensin receptors in melanocytic and keratinocytic tumors and their metastases adds difficulty when attempting to determine the relative importance of each of these two components (i.e. nitrosamines and angiotensin receptors) in the context of carcinogenesis. Case report: We report a 40-year-old patient with arterial hypertension with a duration of skin complaints of about 7 months, clinically manifested by 1) the appearance of a solitary tumor near the medial corner of the left eye, verified histologically as Basal Cell Carcinoma (BCC), and 2) multiple, eruptive dysplastic nevi in the area of the posterior sweat gutter. The patient’s systemic medications included: bisoprolol 5mg (1-0-1 / 2) and indapamide 1.5mg (1-0- 0), taken for one year, and 2 years of treatment with amlodipine / valsartan - 5 mg / 160 mg (1-0-1/2) for an initial period of 1 year, followed by a reduced dose of (1/2-0-0) for an additional year. Conclusion: We report the simultaneous development of basal cell carcinoma and dysplastic nevi after the use of a preparation containing generic valsartan. We discuss 1) the role of nitrosamines as possible major factors in the development of dysplastic nevi and BCC; 2) the possible effect of sartans themselves on angiotensin receptors in the skin and: 3) a new, innovative scheme for treatment of drug-induced BCC by cryoimmunotherapy. Keywords Nitrosamines; Valsartan; Angiotensin Receptor Blockers; Arterial Hypertension; Melanoma; BCC; Cryoimmunotherapy

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Telmisartan/hydrochlorothiazide

2021

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Telmisartan/hydrochlorothiazideNevus-associated cutaneous melanoma: case report A 67-year-old man developed nevus-associated cutaneous melanoma during treatment with telmisartan/hydrochlorothiazide for hypertension.The man, who had hypertension, had been receiving telmisartan/hydrochlorothiazide 80/12.5mg twice a day [route not stated] and amlodipine for 3 years. His comorbidities included dyslipidaemia, atrial fibrillation, benign prostatic hypertrophy and diabetes mellitus, for which he had been receiving metformin, rosuvastatin and amiodarone. He was a phototype-II without reliable evidence of intense and unprotected sun exposure. At the end of 2018 (about 2 years after the initiation of telmisartan/hydrochlorothiazide), the initial pigmented nevus was first noticed. Over the time (within a relatively short time), the nevus changed its colour and shape, and it acquired dermatoscopic and clinical criteria for cutaneous melanoma. The surgery was planned in January, which was postponed to September due to COVID-19 and it's restrictive measures on hospitalisation and surgery. After dermatoscopic and clinical examination, he was hospitalised due to suspicion of cutaneous melanoma.The man underwent surgical treatment, and the suspected lesion was removed by deep elliptical excision (2cm surgical margins in all directions). For the resulting defect, he underwent plastic surgery procedure. Histopathological examination was consistent with nevus-associated cutaneous melanoma with clear resection margins with penetration of tumor cells in the reticular dermis, a lymphocytic stromal reaction, one mitosis per mm 2 and Breslow thickness of 0.6mm. There were no findings of vascular or perineural infiltration or satellite lesions. An associated compound melanocytic nevus with a diameter of 3mm was observed. Initial screening showed no presence of metastases. CT scan of the body and head performed 14 days after the surgery showed no evidence of metastases. Thereafter, he was referred to the regional oncology dispensary for follow-up.

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Telmisartan/hydrochlorothiazide-induced nevus-associated cutaneous melanoma: first report in the medical literature

Cited by 11 publications

References 19 publications

Adverse Drug Reactions: Nitrosamine (and/or Telmisartan/HCT) Induced Nevus and Epidermal Scalp Cyst

Adverse Drug Reactions: Nitrosamine (and/or Telmisartan/HCT) Induced Nevus and Epidermal Scalp Cyst

Valsartan (or/and Nitrosamine) Induced BCC and Dysplastic Nevi: Current Insights

Telmisartan/hydrochlorothiazide

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