Malignant melanoma is an oncologic disease, whose current management among others includes surgical and immunological therapy. According to the current recommendations of the American Joint Committee on Cancer, the surgical excision of the primary tumor should be performed in two operative sessions, which has several consequences. The following paper will present and discuss six cases of pigmented lesions and the advantages of the one‐step melanoma surgery in their management.

The data in the medical literature about the possible development of cutaneous melanoma and dysplastic nevi after therapy with sartans in the world literature are already dozens. The role of the renin angiotensin system in various cancers such as melanoma but breast cancer also seems to be discussed in the past, in the present, but seems to be still the subject of many future discussions, which do not have a definitive solution. We describe the first case of multiple cutaneous melanomas in the world literature, which developed simultaneously after the introduction of systemic antihypertensive therapy with Valsartan. Given the already established role of the renin angiotensin system in melanogenesis, as well as the possibility of promoting carcinogenesis through the practical influence of the “pure substance” of sartans, their widespread use in the treatment of hypertension should be seriously debated. Keywords: Melanoma, Melanogenesis; Antihypertensive Therapy; Valsartan, Sartans; Surgery; Multiple Primary Melanomas

The need of big, longitudinal studies in this subject is constantly increasing. They should confirm or reject our statement, because the simultaneous manifestation of two events does not necessarily mean they are causally related.

The divergent, personalized approach in the surgical treatment of cutaneous melanoma is the one in which the treatment of the neoplasm differs from that proposed within the generally accepted standards or guidelines. According to their presumption, guidelines are not obligatory for the treatment of a certain type of disease and cannot replace the judgment of the clinician. Which to a large extent determines the freedom (or possible one) of the clinician‘s action regarding the „personalization“ in the choice of a new, divergent therapy. It is interesting, for example, that the occurrence of locoregional recurrences in patients with melanoma after guideline therapy insures clinicians against both criticism of treatment choice and the end results. However, the lack of recurrences after innovative/personalized surgical treatment of cutaneous melanoma is accompanied for unknown reasons by a serious dose of unwarranted criticism. The fact is that a personalized surgical approach in the treatment of skin melanomas and the recommended by AJCC guidelines approach lead to exactly the same end results and that should not be ignored. The difference lies in the fact that this end result can be achieved by one step melanoma surgery (OSMS), for example, which is carried out in a single surgical session. Several advantages of OSMS can be noted: 1) it provides high efficiency in a short time, even in the initial stage of the disease, 2) it is cost-effective, and 3) according to initial clinical observations we have a much lower to no propensity for locoregional relapses.

We present a 39-year-old male patient with skin tumor, localized on the scalp, paranoid schizophrenia and an idiopathic aplastic anemia. The patient presents with a lesion in Regio occipitalis, which occurred a few years ago and progressively enlarged to a big exophytic tumor, causing pain and occasional bleeding (Figure 1a-d). The patient has been diagnosed with a paranoid schizophrenia more than ten years ago, and since then is on therapy with Amisulpride 400mg/d and Haloperidol 2x1,5 mg/d. He does not follow his therapy strictly, but hospitalization has not been necessary. In 2016 the patient has been diagnosed with idiopathic aplastic anemia and since then is on immunosuppressive therapy with Cyclosporine A 2x100mg/d. During the dermatological examination we established a well demarcated, 4x4cm, partly pigmented, exophytic tumor in Regio occipitalis with severe perilesional erythema. The lesion had erosive and necrotic areas and was covered by serous and hemorrhagic crusts with different size (Figure 1a-d). A severe and painful, cervical and occipital lymphadenomegaly was