Ramipril Induced BCC and Dysplastic Nevus: Nitrosamine Contamination as Most Potential Trigger for The Development of Melanoma and Nonmelanoma Skin Cancer?

The patient reported four operations in the left nasal area resulting in recurrences over time. The surgical interventions were performed in 2016, 2017, 2022. An appendectomy, cholecystectomy, femur fracture with subsequent implant replacement and pulmonary thromboembolism were also reported in the recent years. From 2008 an arterial hypertension was diagnosed for which the patient was taking the following medications: metoprolol succinate 50 mg once in the morning; from 2010 – ramipril 5 mg once at night and from 2022 apixaban 5 mg once in the morning and once in the evening. No reports for malignancy in any family member, no allergies nor painful sunburns in the nose area declared. The patient requested a further therapeutic approach to be established. The dermatology examination showed in the left ala of the nose, a papule with a pearly edge, superficial telangiectasias and a waxy appearance [Figure 1a]. The lesion was suspected for basal cell carcinoma. Above the left nasolabial fold a plaque with uneven pigmentation was observed – suspected for lentigo maligna [Figure 1b]. In the left axillary region, a tumor-like formation with an irregular shape and inhomogeneously distributed brown to black pigmentation was noticed– suspected for a dysplastic nevus [Figure 1c and 1d].