KARAPANDZIC FLAP FOR SQUAMOUS CELL CARCINOMA OF THE LOWER LIPP: POTENTIAL ROLE OF NITROSAMINES IN EPROSARTAN AS CANCER TRIGGERING FACTORS.

Chronic alcohol use, smoking, poor dental hygiene, absorbed sun radiation over the years, fair skin (Fitzpatrick type 1), light eyes, painful sunburns, congenital or acquired immunosuppression, certain rare syndromes, as well as infections with human papillomaviruses are perceived as risk factors for the development of squamous cell carcinoma of the lips. The new and at the same time modern aspects involving the pathogenesis of keratinocyte tumors in practice prove to be quite problematic for both patients and clinicians. These aspects are involved in the contamination or increased availability of certain nitrosamines in the antihypertensive medications. A serious international study in the last year has linked the intake of potentially contaminated (established availability without data on whether it exceeds the so-called ADI/acceptable daily intake dose) with nitrosamines valsartan with a relatively low, but still present risk of melanoma development. On the other hand, data from 2017 associate individual monotherapy of arterial hypertension with sartans with a significantly increased/statistically significant risk of squamous cell carcinomas development: more than a two-fold increased risk. It should be noted that at that time the problems with nitrosamines were completely unknown to the medical community. At the moment, there are numerous case studies that connect the use of sartans with the development of keratinocyte tumors - either single or multiple. We describe the first case of a patient who took eprosartan at a dose of 600 mg once a day for a total period of about 15 years with intake interruptions of no more than 6 years. Primary complaints in the lower lip area are from about 6 months. The preoperative biopsy showed evidence of squamous cell carcinoma. A multidisciplinary team performed a successful surgical treatment using the Karapandzic method, achieving an optimal aesthetic result. Based on the available literature data, the possible role of nitrosamines as a potential trigger for the development of squamous cell carcinoma is discussed.