Telmisartan (and/or nitrosamine) - induced occult melanoma: first reported case in world literature

ABSTRACT

Introduction: The known connections between the terms ‘sartans’ and ‘melanoma’ has grown recently in the clinical field, suggesting that the relationship between these concepts is very likely to be significant, rather than hypothetical or unfeasible. This is because: 1) the presence of angiotensin receptors in melanoma tissue, melanocytes and skin is a known fact; 2) the influence of sartans on the processes of melanogenesis has already been presented in recent published scientific papers; 3) key in vitro studies have shown that angiotensin receptor blockers (sartans) could potentiate carcinogenesis in the direction of melanoma and metastases; and 4) clinical examples of the occurrence of melanoma after starting therapy with sartans have become numerous and difficult to ignore.

Areas covered: We report the first case of occult melanoma in an 87-year-old Bulgarian patient, this manifested in the form of a solitary metastasis on the left arm, which occurred after long-term therapy with telmisartan.

Expert opinion: The fact that nitrosamines have a proven carcinogenic effect and are the cause of heterogeneous neoplasms shows that they have the potential to be possible melanoma triggers. The multifactorial pathogenesis of melanoma could certainly be clarified after the ‘crystallization’ of this currently serious issue.

KEYWORDS:

• Telmisartan
• nitrosamines
• drug-induced cancer
• valsartan
• melanoma
• surgical treatment
• occult melanoma
• angiotensin receptor blockers
• angiotensin receptor antagonist

Article highlights

• Clinical information on variably localized melanomas and their prognosis following valsartan, irbesartan and olmesartan therapy has long been available. In addition, more and more experimental and clinical-pathological data speak in favor of a causal - rather than an associative or sporadic - relationship.

• Systemic treatment with ARBs and the subsequent development of melanoma is not something new as a clinical observation and has already been reported back in 2015/2016 in retrospective studies based in America and Europe.

• The complex nature of the whole problem comes not only from the lack of prospective clinical trials, but also from the difficulty in clarifying whether nitrosamines themselves are able to cause melanoma.

• Dose-dependent time intervals for melanoma generation (primary lesion generation intervals) are important for the interpretation of the available literature and the demonstration of a possible causative drug-cancer relationship.

Acknowledgments

The authors would like to thank J. Wilcock for his editorial assistance, and assistance in helping with spelling and grammar throughout the manuscript.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Patient consent

The patient mentioned in the review gave consent to be discussed in the manuscript.

Additional information

Funding

This paper was not funded.