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Viagra & Melanoma

Viagra use has long been linked to vision and hearing problems, as well as possible heart complications. But its active ingredient, sildenafil, more recently has been linked to a possible increased risk for melanoma, the most dangerous skin cancer.

In 2014, a study published in JAMA Internal Medicine found that the use of sildenafil, more commonly known by its brand name Viagra, within 3 months prior to the study’s start increased the likelihood of developing melanoma by as much as 84 percent.

The study included a total of nearly 26,000 male participants who were followed by researchers for 10 years. Additionally, this study found that men who reported using Viagra any time before the beginning of the study were 92 percent more likely to be diagnosed with melanoma than men who reported that they had never used the drug.

But study co-author Wen-Qing Li said more research is needed prior to concluding that the use of Viagra causes melanoma. Li and co-author Dr. Abrar Qureshi said the study’s results merely point to a correlation, or link, between the two.

A few follow-up studies have been performed since 2014 to look at the potential risk for melanoma with Viagra and similar drugs. Some of these studies found an increased risk of melanoma among patients who used Viagra (or other similar drugs), but other studies did not find a significant connection between Viagra use and melanoma, and none of these studies have proved that Viagra is a true cause of melanoma. In 2017, an article looked at data from 866,049 men in 5 studies and determined that, although the use of Viagra or similar drugs was associated with an 11% increase in risk for melanoma, it is not likely that these drugs actually cause melanoma.

In an editorial accompanying the 2014 study, Dr. June Robinson of Northwestern University’s Feinberg School of Medicine said doctors treating older men taking Viagra should also be checking them for signs of skin cancer. Men make up about 66 percent of the melanoma deaths in the U.S.

What is Melanoma?

Skin cancer is the most common type of cancer in the U.S., most often affecting a person’s head, face, neck, hands and arms. There are three major subgroups of skin cancer: basal cell cancer, squamous cell cancer, and melanoma. Basal cell cancer and squamous cell cancer are the most common forms of skin cancer, with melanoma being less common but the most serious of the three.

Melanoma is the leading cause of death from skin cancer. It is caused by changes in skin cells called melanocytes. These are the cells responsible for making a person’s skin color pigment (this pigment is called melanin). Melanin is the substance that gives us the color of our skin, eyes and hair.

Melanoma spot on skin
Melanoma is the leading cause of death from skin cancer

While melanoma only accounts for about 1 percent of skin cancers diagnosed in the United States, it causes the most deaths from skin cancer. The American Cancer Society (ACS) estimated that about 100,350 new cases of melanoma will be diagnosed in 2020, with approximately 6,850 of those cases expected to result in death.

The ACS also found that the rates of melanoma have significantly risen over the last three decades, with the American Academy of Dermatology (AAD) estimating that 1 in 5 Americans will develop skin cancer during their lifetime. The AAD stated that melanoma rates in the U.S. have doubled from 1982 to 2011, and currently more than 1 million Americans are living with melanoma. The average annual cost of treating melanoma in the U.S. is estimated to be around $3.3 billion.

Signs and Symptoms of Melanoma

The first sign of melanoma is often a change in the size, shape, color or feel of a mole. It can also appear as a new mole, and may be black, abnormal or “ugly looking.” Most melanomas have a black or black-blue area.

An acronym of “ABCDE” can help patients remember what to watch out for when inspecting their moles:
  • A for Asymmetry
    Meaning if the mole were to be divided in half, are the two halves different in size and shape?
  • B for Border
    Does the mole have irregular edges or borders?
  • C for Color
    Is the mole more than one color?
  • D for Diameter
    Has there been a change in size (most often growing larger)?
  • E for Evolving
    Changes in the mole over a period of weeks or months; is the mole itchy, oozing or bleeding, or is it ulcerated (a hole that forms in the skin)?

Treatment, Prognosis and Possible Complications

The earlier melanoma is discovered, the more successfully it can be treated. Surgery is needed to effectively treat melanoma. According to the American Society of Clinical Oncology (ASCO), most people with melanoma are cured after their initial surgery.

Doctor examining lymph nodes
When melanoma has spread to nearby lymph nodes, they will need to be removed as well

During surgery, the cancer itself, as well as some of the surrounding area, will be removed depending on how deep the melanoma has grown. In cases where the skin cancer has spread to nearby lymph nodes (small bean-shaped glands present throughout the body that help fight off infection), the lymph nodes will be removed as well.

If the cancer has spread to other organs, melanoma becomes much more difficult to treat. At this point, a person’s 5-year survival rate (or the percentage of people still living five years after the cancer is found) drops from about 98 percent to about 23 percent.

Melanoma treatment options may include:
Chemotherapy
Medicine used to kill cancer cells.
Immunotherapy
These are drugs generally used along with chemotherapy and surgery to further assist the immune system in fighting the cancer.
Radiation Treatments
These treatments are used in an effort to relieve pain or discomfort.
Targeted Therapy
These drugs or substances attack cancer cells, but usually cause less harm to normal cells than chemotherapy or radiation.
Surgery
Even after cancer has been spread to other areas of the body, surgery can be useful in removing the cancer and can help to prevent further growth of the cancer. Surgery may also help relieve pain or discomfort caused by the cancer.

Even after recovery, melanoma can return. A patient’s risk of melanoma increases once they have already had the cancer. It is important for an individual at an increased risk of acquiring the disease to undergo regular checks for skin cancer, as melanoma can spread to other areas of the body very quickly.

Side effects of melanoma treatments may include pain, nausea and fatigue.

Viagra Use and Potential for Melanoma

In 2000, 25,848 male participants were questioned about the use of sildenafil (Viagra) and risk factors for developing melanoma as part of the Health Professionals’ Follow-up Study.

Melanoma Results
142 cases of melanoma and 3,752 total occurrences of skin cancer were reported during the 10-year follow-up period. Of the 142 melanoma cases, 14 were reported in patients who had taken sildenafil within 3 months before the start of the study.

Self-reported questionnaires included inquiries as to the men’s sexual health, use of Viagra, and history of sun exposure, as well as their hair color, family history of skin cancer, number of severe sunburns, and history of moles.

The authors of the study concluded that erectile dysfunction (ED) itself was not a factor associated with a higher risk of melanoma. Additionally, the study did not reveal any link between sildenafil use and other skin cancers, including squamous cell carcinoma (SCC) and basal cell carcinoma (BCC).

Overall, it was determined that the use of sildenafil for ED was associated with an increased risk of the subsequent development of melanoma. The authors of the study stated that the findings “cannot prove cause and effect,” nor were they sufficient to “alter current clinical recommendations” about Viagra use. They noted the importance of a “cautious interpretation” of the results and the need for a “longer follow-up and more detailed assessment.”

Since the publication of this study, other studies have also looked at the risk of melanoma with Viagra. These studies also looked at the risk of melanoma with other drugs that work similarly to Viagra. The results of these studies have not consistently shown a link between Viagra use and the development of melanoma: some studies found a small association between Viagra use and melanoma, but others did not find a significant association. A 2017 article looking at data from 866,049 men in 5 studies determined that, although the use of Viagra or similar drugs was associated with an 11% increase in risk for melanoma, it is not likely that these drugs actually cause melanoma. No study has demonstrated that Viagra is a direct cause of melanoma.

The Potential Link Between Viagra & Melanoma

Wen-Qing Li and study co-author Dr. Abrar Qureshi pointed to one theory for the correlation between the use of the erectile dysfunction (ED) drug Viagra (sildenafil) and the increased likelihood of melanoma development.

Fact
Viagra helps patients get an erection by suppressing the phosphodiesterase (PDE) 5A enzyme, a process that mimics the activation of a mutation commonly seen in melanoma.

Viagra helps patients get an erection by suppressing a naturally occurring enzyme in the body, known as the phosphodiesterase (PDE) 5A enzyme. Additionally, as reported by Men’s Health, this process “mimics the activation of a mutation commonly seen in melanoma.”

The PDE5A enzyme is regulated by what is known as a BRAF gene, which belongs to a class of genes known as oncogenes. The BRAF gene provides instructions for making a protein, a part of a signaling pathway known as the RAS/MAPK pathway, that helps send chemical signals from outside the body’s cells to the nuclei.

As a whole, the RAS/MAPK pathway is responsible for regulating the growth and division of cells, the process by which they mature and carry out specific functions, their movement, and their self-destruction. The chemical signaling that occurs across this pathway is essential for normal development prior to birth, according to the National Institutes of Health (NIH).

When BRAF genes, or oncogenes, become mutated, they have the potential to cause normal cells to become cancerous. PDE5A is lowered, or inhibited, when these mutated BRAF genes are activated, and it is thought that the decrease in PDE5A caused by mutated BRAF genes increases the invasiveness of melanoma cells. Since Viagra (sildenafil) also inhibits the action of PDE5A in a different way, this could potentially explain why an increased risk of melanoma was seen in patients who used Viagra.

However, other researchers have proposed an alternative theory for why some studies has seen an association between Viagra use and melanoma: patients who are taking Viagra may simply be more likely to interact with their health care providers on a regular basis. This means that they may be getting screened for melanoma more often than patients who are not taking Viagra. Because they are being screened more often, they are more likely to be diagnosed with melanoma if they have it. Studies may not have considered all the factors that increase a person’s risk for melanoma diagnosis, so the true reason for the increased melanoma risk among Viagra users may not be related to Viagra itself.

Please seek the advice of a medical professional before making health care decisions.

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Kristin Compton
Written By Kristin Compton Writer

Kristin Compton's background is in legal studies. She worked as a paralegal before joining Drugwatch as a writer and researcher. She was also a member of the National Association of Legal Assistants. A mother and longtime patient, she has firsthand experience of the harmful effects prescription drugs can have on women and their children. Some of her qualifications include:

  • Bachelor of Arts in Legal Studies | Pre-Law from University of West Florida
  • Past employment with The Health Law Firm and Kerrigan, Estess, Rankin, McLeod & Thompson LLC
  • Personal experience battling severe food allergies, asthma and high-risk pregnancies
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16 Cited Research Articles

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  2. American Cancer Society (ACS). (2019). Cancer Facts & Figures 2019. Retrieved from: https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2019/cancer-facts-and-figures-2019.pdf
  3. American Cancer Society (ACS). (2019, August 14). Key Statistics for Melanoma Skin Cancer. Retrieved from: https://www.cancer.org/cancer/melanoma-skin-cancer/about/key-statistics.html
  4. American Society of Clinical Oncology (ASCO). (2019). Melanoma: Statistics. Retrieved from: https://www.cancer.net/cancer-types/melanoma/statistics
  5. Firger, J. (2014, June 4). Viagra may increase melanoma risk, study finds. Retrieved from: https://www.cbsnews.com/news/viagra-may-increase-melanoma-risk/
  6. Li, W. et al. (2014). Sildenafil Use and Increased Risk of Incident Melanoma in US Men: A Prospective Cohort Study. Retrieved from: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1857095
  7. MedlinePlus, NIH. (2019, December 16). Melanoma. Retrieved from: https://medlineplus.gov/melanoma.html
  8. MedlinePlus, NIH. (2020, January 6). Melanoma. Retrieved from: https://medlineplus.gov/ency/article/000850.htm
  9. National Cancer Institute, NIH. (2019, November 8). Melanoma Treatment (PDQ®) – Patient Version. Retrieved from: https://www.cancer.gov/types/skin/patient/melanoma-treatment-pdq
  10. NBC News. (2014, April 7). Viagra May Boost Risk of Deadly Skin Cancer, Study Finds. Retrieved from: https://www.nbcnews.com/health/health-news/viagra-may-boost-risk-deadly-skin-cancer-study-finds-n73976
  11. NIH. (2018). BRAF gene. Retrieved from: https://ghr.nlm.nih.gov/gene/BRAF
  12. Sgobba, C. (2014, August 28). The Scary Side Effect of Viagra. Retrieved from: https://www.menshealth.com/health/a19518974/viagra-increases-melanoma-risk/
  13. Loeb, S. et al. (2015). Use of Phosphodiesterase Type 5 Inhibitors for Erectile Dysfunction and Risk of Malignant Melanoma. Retrieved from: https://jamanetwork.com/journals/jama/fullarticle/2338254
  14. Pottegård, A. et al. (2016). Use of sildenafil or other phosphodiesterase inhibitors and risk of melanoma. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5046205/.
  15. Wang, J. Z. et al. (2019). No Causal Link between Phosphodiesterase Type 5 Inhibition and Melanoma. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6704303/
  16. Loeb, S. et al. (2017). Meta-Analysis of the Association Between Phosphodiesterase Inhibitors (PDE5Is) and Risk of Melanoma. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5437700/
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