The Bulgarian Society for Dermatologic Surgery (BULSDS) was founded in 2018 with a focus to augment dermato-surgery within the ever developing speciality of dermatology in Bulgaria. Alongside this vision, the society also promoted interdisciplinary collaboration, while advocating for increased support and mentorship for young scientists and specialists with a dermatological/dermatosurgical interest. The society also works in partnership with international colleagues to bring unique insight into the field of dermatologic surgery within Bulgaria.
The Annual National Conference of the Bulgarian Society for Dermatologic Surgery 2022, was held in the capital city of Sofia, Bulgaria on the 12th March, 2022.
The Fourth National Congress of BULSDS attracted specialists from both national and international platforms.
The congress this year focused its attention on cancer, in particular, skin cancer and melanomas with Personalised (one-step) melanoma (surgical) treatment (OSMS), adverse drug- induced melanoma and nonmelanoma skin cancer taking centre stage.
This report brings to light some of the main research undertaken within this field that has received high impact-factor recognition in world literature.
Such a platform invites an opportunity for direct debate with distinguished scientists from around the world, enabling to discuss our innovative discoveries, hypotheses and observations.
The first session was introduced by one of our esteemed guest scientists, Professor Dr Ricardo Vieira with his presentation on an holistic approach of the current surgical management of melanomas in Europe as well as the probable benefits of applying One Step Melanoma Surgery for such cancers. The talk was very well received by the scientific delegation present, with many positive comments discussing the direction in which the management of treating melanomas was heading into, in the future.
Our second key-note speaker, renowned dermatopathologist Dr Jose Carlos Cardoso discussed the pathognomonic relation and progression of melanoma with focus on histopathological diagnosis and therapy.
The session carried on with the major focus on our personalised treatment strategy for malignant melanoma, already introduced in the Lancet by Professor Georgi Tchernev and colleagues in 2015.1,2 The lectures centred around this well-established surgical treatment for melanoma. The session led to an open debate on the topic of the current AJCC guideline update, that suggest a possibility of extending additionally the surgical sessions if the surgical margins are within close proximity to tumour tissue according to histopathology. The tailored personalised One Step Melanoma Surgery’s’ (OSMS) fundamental focus this year was on the possibility of absolute reciprocity between (pre-operative) clinical and (postoperative) histopathological surgical margins.3 Additionally, we introduce for the first time in the literature, two subgroups of borderline intermediate thickness melanomas class A (1mm-2mm) and B (2mm-4mm), where we suggest one step surgical approach with a total of 2cm and SLNB simultaneously for both subtypes.4,5 The principle benefits of OSMS is to provide the clinician with a more precise guideline to work with, alongside giving lesser opportunities for deviations as well as fewer surgical interventions, reduced psychological stress for the patients as well as alleviating financial burdens.
This session brought about an opportunity for discussion and debate within the group of international experts on the personalised one-step approach as well as some concerning thoughts regarding this treatment strategy for dysplastic nevi, intermediate to thick melanomas (greater than 2mm).6,7
The second session centralised on the hot-topic of adverse drug reactions of antihypertensive medications and their contaminants such as Nitrosamines and their potential role in the possible pathogenesis of melanoma and other various cancers.8,9
This core topic was thematized at our first congress in 2019. For the first time this year, we showcase the clinical data of Sartans alongside other routinely used drugs including Hydrochlorothiazide (HCT) and Metformin and its potential role in carcinogenesis with its possible key contaminant -nitrosamines.8,9
Impurities within these drugs came to light when further inquiries were made by the public, with the FDA changing its stance from acceptable daily intake limits to the withdrawal of large batches from major pharmaceutical companies.10
An active lawsuit has been filed against the drug, Zantac (ranitidine) due to the contamination with NDMA and subsequent development of various cancers in individuals taking this drug.11 FDA found active ingredient ranitidine containing the carcinogen, which was later withdrawn from the market in large batches in mid-2020. When the lawsuit was announced in February 2022, patients were able to claim compensation against 10 different cancers, including melanoma, bladder, gastric and esophageal cancers.11 However, as of 5th of May 2022, the list of cancers that qualify for the Zantac lawsuits was amended from 10 to 5 with the removal of cancers of the breast, colon, ovarian, kidney as well as melanoma of the skin.11 Such and similar observations were critical in the discussion, leading to intense debate especially with the concerns of the contaminants within antihypertensive drugs and metformin and their possible role with the induction of nevus associated melanoma and many other carcinomas.
Image 1.
Prof Dr G Tchernev in energic discussion with Prof Dr Ricardo Vieira and Dr Jose Carlos Cardoso about the applicability of One Step Melanoma Surgery as possible adequate surgical approach in selected melanoma patients: Facts and controversies.
Image 2.
Dr Nikhil Oliveira presenting a lecture about the possible connection between Nitrosamines in Sartans and Hydrochlorothiazide and the development of Skin and other cancer types. Prof Dr Ricardo Vieira and Prof Dr Georgi Tchernev prepare their questions by listening carefully to the presentation.
We presented here, for the first time, alongside sartans, other commonly prescribed drugs (HCT, Metformin), some of them with possible nitrosamine contamination that could also be the culprit and the main source inducers of nevus associated or occult melanomas for example. Key speakers in the first two sessions were Dr Nikhil Oliveira and Dr Lorraine Joseph Kandathil.
Our afternoon sessions soon began with our fellow-colleague Dr Ivan Pidakev who presented a unique case of intergluteal pilonidal cyst as an uncommon manifestation in acne inversa/hidradenitis suppurativa and the success in surgical treatment in patients with severe form of the disease, treated under common anesthesia.
Followed by Dr Atanas Batashki with case discussions of giant lipoma situated on the back. Our young colleagues and scientists then took to the podium to present several rare cases in dermatology, showing professionalism as well as critical insight in the unique conditions presented in our clinics. This session showed a variety of cases and discussions from all aspects of nonmelanocytic skin cancers to the surgical approach to many unique dermatological diseases.
The closing session of cutaneous lymphomas was set in motion by Dr Tania Popova and Dr Konstantin Stavrov who discussed cases of mycosis fungoides with possible monotherapy with bexarotene describing successful long-term control of advanced primary cutaneous lymphomas. Further discussion of treatment with pixantrone in cases of relapsed refractory diffuse B-cell large lymphoma with cutaneous involvement was seen to be successful. Controversies of the well- established truth behind drug associated pemphigus and potential trigger factor of autoimmunity was discussed again by Dr Konstantin Stavrov.
Dr Konstantin Stavrov goes on to describe how autoimmune responses are similar in drug-related and non-drug induced disease where bound and serum autoantibodies to DSG1 and/or DSG3 are shown, suggesting a similar underlying molecular mechanism.
Due to COVID-19 and its limitations, few of our keynote speakers were unavailable to attend our congress in person, nevertheless with the boundless access of technology, Prof Dr Uwe Wollina took part in a video lecture who interpreted important data on sarcoid-like reactions observed in patients with melanoma.
Prof Dr Pietro Nenoff finally closed the session with the latest update on the diagnostics and antifungal resistance in Dermatophytoses in Germany and also his Indian experience.
This fourth national congress of BULSDS has become a bridge for partnership, close cooperation and mutual assistance between specialists in the country, but also to our extended specialists overseas. The congress was once again an exceptionally successful event that showcased the latest achievements in the field of dermatosurgery, dermo-oncology and beyond.
Funding Statement
Funding: None.
References
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