Discover Oncology: The Interplay Between the Food/Drug Related Nitrosogenesis Based on ROS/Nitric Oxide (NO) Interaction: The Two of the Most Powerful Factors Responsible for the Photo Nitroso Carcinogenicity Concerning the Skin Cancers Pathogenesis

Processes concerning concepts such as phototoxicity/ photodecomposition with subsequent development of photo carcinogenicity and skin cancer generation are also influenced/modulated by drug and food intake.It is the drugs and foods that determine or define the concepts of Nitrosogenesis and Nitroso mediated Photo carcinogenesis of skin cancer. Nitrosamines are well known phototoxic/ photolabile substances from the distant past, some of them also having additional carcinogenic or mutagenic effects. The intake of nitrosamines with the drugs can be 1) in the framework of the so-called nitroso contamination or the intake of a ready carcinogen that has already occurred outside the body, such as NDEA, NMBA, NDMA, etc. or 2) they arise de novo in the organism when the following prerequisites are present: 2. 1) the presence of a secondary or tertiary amino group in the respective drugs, 2. 2) the presence of a gastric or acidic environment and 2. 3) the presence of nitrite-rich food. In practice, it appears that diet largely defines drug-mediated mixed-type Photo Nitrosogenesis/Photo Nitroso- Carcinogenesis, and hence skin cancer incidence.Therefore, the simultaneous intake of some nitrite-rich foods such as Broccoli, Cabbage, Carrot, Cauliflower, Celery, Cucumber, Leek, Lettuce, Parsley, Pumpkin, Red beetroot, Spinach for example, together with some drugs could appear to be risky for the skin cancer generation. On the other hand, the food itself could also be a direct donor of finished nitrosamines such as NDMA: cured meats, fish, and alcoholic beverages like beer and whiskey/ NDEA- in processed meats.In practice, the exogenously defined, but this time predominantly nutritionally mediated, Nitrosogenesis concerning skin cancer mirrors the drug medicated one and could also be considered as 1) exogenous, based on direct intake of finished carcinogens with foods, or 2) mixed type : Namely, 1) intake of nitrite-rich foods, which in 2) under stomach conditions/acidic/ and 3) intake of secondary or tertiary amines with the medication. The greater the number of drugs taken by a patient, the higher the risk of taking 1) drugs with pure phototoxicity/not nitrosamine related/ non nitroso contamination-based effects, but also 2) those whose final photocarcinogenicity could be defined on the basis of taking 2.1) finished , completed nitrosamines, as well as 2.2) those that are subsequently converted into such. In this context, we report a patient, who developed a high-risk tumor near the eye under systemic treatment with : (nitroso-) metoprolol, (nitroso-) torasemide, (nitroso-) rosuvastatin, (nitroso-) ezetinib, Nitroso acetylsalicylic acid (NO-ASA), (nitroso-) piroxicam , (nitroso-) dapaglifozin and (nitroso-) clopidogrel. Whether the role of Nitrosogenesis is discussed in the context of phototoxicity or photodecomposition of nitrosamines in the human body, both processes are characterized by the subsequent generation of genotoxic/ mutagenic substances and DNA damage. The photodecomposition of nitrosamines leads to the release of nitric oxide. The last one interacts with ROS, and this interaction could either promote or suppress carcinogenesis. Low concentrations of NO are thought to promote carcinogenesis. The interaction between NO and ROS influences and modulates the processes directly related to carcinogenesis: angiogenesis, programmed cell death, and cell signaling. Oxidative stress, caused by an imbalance in ROS levels, is a also key factor in the development and progression of skin cancer. This explains why low concentrations of nitrosamines in drugs should be often considered as more dangerous than higher concentrations, as it is precisely these that promote skin cancer when interacting with ROS. Both UVB and UVA are considered generators of ROS in the context of photo carcinogenesis. Subsequent interactions with nitric oxide reinforce the concept of photo Nitrosogenesis/carcinogenesis of skin cancer or Nitroso photo carcinogenesis/Nitroso photo genesis of skin cancer based on drug (but also food) intake. Photocarcinogenicity related to the onset and progression of keratinocyte cancer seems to be nitroso-dependent, regardless of the mechanism by which it is generated: photodecomposition or phototoxicity: in fact the final result is the development of Nitroso Photo Carcinogenicity based on medicinal and/or dietary intake. Correction of this type of adverse drug reactions, namely skin cancer in high-risk areas, could be successfully treated using severe reconstructive surgical techniques such as island flap.