Antihypertensive Drugs and Cancer: Simultaneously Development of Choroidal Melanoma and Colon Carcinoma after Administration with Valsartan/ Hydrochlorothiazide

Recently published experimental data on the presence of different types of angiotensin receptors in melanoma tissue and in breast cancer, for example, are undoubtedly alarming and indicative because Sartan therapy (in certain groups of patients) may be a risk factor for the patients themselves. The reason for this is the ability of the specific group of drugs to promote carcinogenesis by blocking certain types of receptors, presented in certain types of tumors. The available in vivo and in vitro data in the world literature on the influence of antihypertensive drugs (Sartans and Thiazide diuretics) on melanogenesis and development of other cancerous forms, although disputed, are numerous. Even more disturbing are the further data in the medical literature on the development of multiple tumors after administration of Sartans alone or in combination with hydrochlorothiazide. According to other literature data, even monotherapy with the already mentioned diuretic- hydrochlorothiazide, could be seen as a possible key or risk factor for the development of cutaneous melanoma. We present a clinical case of a 67-year-old patient with anamnestic data for systemic antihypertensive therapy with a combined preparation containing Valsartan / hydrochlorothiazide 160 mg / 12.5 mg for the period from the end of 2011 to March, 2020, came on occasion of a prophylactic dermatological examination. The examination found a pigmented lesion in the right torso, clinically and dermatoscopically suspected of thin cutaneous melanoma. According to the anamnesis and available documentation, it is clear that within this combined antihypertensive medication, the patient has developed two additional neoplasms in the recent past: choroidal melanoma and colorectal carcinoma successfully treated surgically. To what extent, the shared data (on the occurrence of multiple tumors after combination treatment with antihypertensives such as sartans and thiazide diuretics) would lead to the necessary and desirable rethinking of therapeutic strategies for the treatment of hypertension and clarification of the mechanisms at molecular level, at this moment - remains unclear. But in practice it should be highly recommended. Keywords: Melanoma; Melanogenesis; Antihypertensive Therapy; Valsartan; Sartans; Surgery; Hydrochlorothiazide

Estrogen Receptor and Progesterone Receptor Positive Pigmented Extramammary Paget’s Disease of the Axilla Mimicking Melanoma: A Case Report and Review of the Literature

Pigmented extramammary Paget’s disease (EMPD) is a rare variant which is often confused clinically and histologically with melanoma or other pigmented lesions. Herein, we describe a rare case of pigmented EMPD involving the axilla of a 40-year-old female thought initially to represent malignant melanoma clinically. Immunohistochemically, the neoplastic cells are positive for Estrogen Receptor (ER), Progesterone Receptor (PR), and weakly positive for Human Epidermal Growth Factor Receptor 2 (Her2). A review of the literature reveals that the pigmented variant of EMPD could be easily misdiagnosed as melanoma initially and additional confirmatory studies are almost always needed to confirm the diagnosis. The expression of ER and PR in pigmented EMPD is rarely mentioned previously. We believe it should be further investigated for the understanding of pathogenesis in pigmented EMPD and the potential role of adjuvant hormonal therapy. Keywords: Extramammary Paget’s Disease; Axilla; Estrogen Receptor; Progesterone Receptor

Sartans and Melanoma: Valsartan Induced Multiple Primary Cutaneous Melanomas: first Description in the Medical Literature!

The data in the medical literature about the possible development of cutaneous melanoma and dysplastic nevi after therapy with sartans in the world literature are already dozens. The role of the renin angiotensin system in various cancers such as melanoma but breast cancer also seems to be discussed in the past, in the present, but seems to be still the subject of many future discussions, which do not have a definitive solution. We describe the first case of multiple cutaneous melanomas in the world literature, which developed simultaneously after the introduction of systemic antihypertensive therapy with Valsartan. Given the already established role of the renin angiotensin system in melanogenesis, as well as the possibility of promoting carcinogenesis through the practical influence of the “pure substance” of sartans, their widespread use in the treatment of hypertension should be seriously debated. Keywords: Melanoma, Melanogenesis; Antihypertensive Therapy; Valsartan, Sartans; Surgery; Multiple Primary Melanomas

Knowledgeof Dermatology Residents on the COVID-19 Pandemic: A Cross-Sectional Study

Background: A novel coronavirus disease (COVID-19) has spread throughout the world leading to a global pandemic. As a result, all healthcare workers have been profoundly affected. Objectives: The goal of our study is to identify the level of knowledge and the effect of COVID-19 on dermatology residents. Methods: A cross-sectional analysis in which 77 dermatology residents from three Gulf Cooperation Council (GCC) countries and Canada completed an online questionnaire-based survey. The questionnaire consisted of four sections: one general information about the resident and three on knowledge, safety measures and impact of COVID-19, with a total of 26 questions. The questionnaire was scored out of 10 with those above the mean considered as having satisfactory knowledge. Results: The mean (SD) knowledge score was 6.25 (1.6). There was a statistically significant difference noted between the GCC countries and Canada in terms of the knowledge score (p-value=0.035). Only 14% of dermatology residents felt competent in managing COVID-19 patients. Seventy percent felt that the pandemic has negatively affected their dermatology training. Conclusion: Dermatology residents demonstrated a difference in knowledge score in relation to the geographic location of the program. Almost 46% of residents illustrated a satisfactory knowledge score about COVID-19. Only a small percentage of residents are confident in treating COVID-19 patients. Subsequently, the need for improved education of residents regarding COVID-19 before redeployment is warranted.

Keratinocytic Cancers - Ambulatory Surgical Approach: Case Series

The Keratinocytic cancer is the most common form of skin cancer and the most common cancer in humans. Predisposing risk factors include ultraviolet radiation, genetic predisposition, chronic immune suppression, smoking, which also determines the risk groups - middle and old age, light skin phenotype, outdoor work and frequent sunburns. The origin of the epidermal cell type determines the clinical division of keratinocytic cancer into basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Clinically, keratinocytic cancer is presented as a solitary, sometimes destructive, growing-sized lesion. The most lesions are characterized by a low degree of malignancy. Neglecting them by both the patient and medical professionals leads to their growth and metastasis, as SCC has a higher potential for metastasis. The main place in the treatment of keratinocytic cancer is the surgical method, and the most common in clinical practice is the so called elliptical excision. The gold standard in hardto-reach places is the Mohs micrographic operation. In this publication we present eleven clinical cases of patients with keratinocytic cancers in different topographic regions of the human body. Patients were treated surgically by elliptical excision and complete removal of tumor formations in accordance with the recommended fields of surgical safety. The defects were closed with single skin sutures and the sutures were removed on the 14th postoperative day. No complications were observed in the postoperative period. Keywords: Keratinocytic Cancer; Basal Cell Carcinoma; Squamous Cell Carcinoma; Elliptical Excision; Dermatosurgery

Epidermal Cysts Surgery: Case Series

Epidermal cysts are the most common scalp cysts in clinical practice. They are most commonly located in the region of the face, neck, and trunk, and have been reported in many other topographic areas of the body. Clinically, they are present as free-moving nodules located below the skin, ranging in size from a few millimeters to a few centimeters in diameter. Histopathologically, they are defined as benign tumor formations with a very low risk of malignancy. The differential diagnosis includes: lipoma, neurofibroma, salivary gland adenoma, vascular lesion and fibroid, and Trichilemmal cyst. The most common treatment for epidermal cysts is surgical excision with removal of all contents without compromising the integrity of the capsule. In this publication, we present five clinical cases of patients with epidermal cysts in different topographic regions of the body. The patients were treated surgically by elliptical excision and complete removal of epidermal cysts without rupture. The defects were closed with single discontinued skin sutures and the sutures were removed on an 8- / 14-postoperative day. No recurrence was observed in the postoperative period.

CASE REPORT: The impact of Plasma Exeresis after fillers complication on the lips

The purpose of this article is to inform the medical audience about the treatment of difficult cases by implementing the Plasma Exeresis method. With the particular device of Plasma Exeresis the fourth state of matters, Plasma, is produced. In brief, Plasma Exeresis is a certified cordless micro-surgical hand-operated device. According to the histology results, Plasma Exeresis sublimates the epidermis without passing the membrane basal, shrinking the elastic fibers of the dermis, and produces collagen type III without the unwanted skin lesion. In particular, by using Plasma Exeresis with the above mechanism we are able to rectify the fibrosis and granules (and other medical lesions e.g. xanthelasmas, hemangioma, non-invasive blepharoplasty, papilloma, fibroma, benign tumors, etc.). Furthermore, it accelerates the damage repair, the wrinkles softening and the skin fibers regeneration. The case study discussed below can be characterized for its hard and challenging nature, bearing in mind that the damage was extensive. The patient was a woman, 55 years old, who had undergone an unsuccessful treatment in the past. The case takes place in Greece. The culprit was the application of lip fillers consisted of an unknown material. The adverse effects (granules) (See pictures below) were combined with depressive disorder which lasted for approximately 15 years. The granules were considered by many doctors (even plastic surgeons) insurmountable, however, the Plasma Exeresis method was eventually highly effective. Consequently, the Plasma Exeresis can be considered as an innovative method which can heal and restore problematic cases. Keywords: Plasma Exeresis: Fillers; Complication; Lips; Side Effects; Granules Hypothesis 1: Plasma Exeresis can cure difficult cases

The Difference of Melanin Index in Treatment of MelasmaUsing Non-Hydroquinone Cream and Kligman's Formula

Melasma is a hyperpigmented lesion that occurs on different skin areas that are often exposed to sunlight with predilection arising on the face, neck, and partially on arms or other body parts. It is also known as chloasma or black colour. This pigmentation disorder is common to people with IV-VI type of skin, and those living in the environment with more Ultraviolet (UV) exposure. Yet, its etiology has not been understood clearly. The major influential factors on its pathogenesis are UV radiation exposure, endocrine factor, genetic predisposition, the phototoxic/ photoallergies medicine,anticonvulsant medicine,particularly cosmetics, and nutrition deficiency are reportedly less influential or a rare factor. The aim of this research is to prove the difference between melanin index number on melasma patients having therapies by using non-hydoquinone cream and Kligman’s formula.