High Risk BCC of the Nose After Telmisartan Hydrochlorothiazide: Potential Role of Nitrosamine Contamination as Key Triggering Factor for Skin Cancer Development

A 62-year-old male presented in the dermatology department with primary complaints of a 1-year-old lesion located in the right upper nose segment. He noticed the formation growing in size and changing its texture. The patient denies having allergies or any malignancy in any family member. He has arterial hypertension for which he takes bisoprolol 10 mg once in the morning, amlodipine 10 mg once in the evening, spironolactone 25 mg once in the morning, atorvastatin 20 mg once in the evening and from 5 years till present telmisartan/hydrochlorothiazide 80/12.5 mg once in the morning.For five years the patient took clonidine hydrochloride 0.15 mg once daily and for a year - prazosin 2mg once daily. Now the clonidine hydrochloride is administered when needed. The patient requested a physical examination and further therapeutic approach to be established. The dermatological examination showed an elevated large lesion with crusts and regular borders located in the right upper nasal region, in close proximity to the right eye [Figure 1]. The lesion was suspected clinically for basal cell carcinoma.