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Viagra and skin cancer

What part if any does viagra have in causing skin cancer?

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Viagra was the first medication produced to treat erectile dysfunction and first appeared in our pharmacies in 1998. It was hailed as the ‘wonder drug’ for men who suffered from erectile dysfunction and it has continued to help men for more than two decades.

The active ingredient which is found in Viagra is sildenafil and it was first developed for use as a drug to treat angina. It wasn’t very effective when used to treat people suffering from angina but a very interesting side effect was noted - that it improved the quality and number of erections experienced by men taking the medication.

Sildenafil falls into the category of drugs called phosphodiesterase 5 inhibitors (PDE 5 inhibitors); the group also includes tadalafil (Cialis), vardenafil (levitra) and avanafil (Stendra). They operate as vasodilators which enable an increased blood flow to the penis, the engorgement of which is necessary to achieve an orgasm.

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Viagra and melanoma

A study published in 2014 in the Journal of American Medical Association (JAMA) reported its findings with regard to the use of sildenafil (Viagra) and the increase in the risk of developing melanoma.

Almost 26,000 men were involved in the study. They had all begun using Viagra in the three months prior to beginning the study and they were followed by the research team for ten years. It was found that there was an 84 percent higher risk of developing melanoma and those men who also reported having used Viagra before this had a 92 percent higher risk. This was compared with men who had never used Viagra.

It was suggested by the co-author, Wen Qing Li that more research was needed before it could be categorically concluded that Viagra causes melanoma; the study only suggested a correlation between the two things.

There have been a number of studies performed subsequently looking at the risk of developing melanoma as a result of using Viagra or other PDE 5 inhibitors. Some of the studies found an increased risk of developing melanoma and others found no risk at all; none of the studies proved that Viagra or other similar drugs caused melanoma.

A later study published in 2017 took data from 866,049 men taken over five different studies. They managed to determine that Viagra and other PDE 5 inhibitor drugs are associated with an 11% increased risk of developing melanoma but it would seem unlikely that the drugs are actually the cause of melanoma.

What is melanoma?

Melanoma, also known as malignant melanoma is a form of skin cancer;  the most common cause of this type of cancer is over exposure to the sun.  The first sign of melanoma is most often seen as a change in the appearance of a mole already on your body or the appearance of a new mole.

If caught early enough, localised surgery and removal of the mole is usually the only treatment required.  However, if it has spread other treatments such as radiotherapy may be required.

The best form of prevention when it comes to melanoma is to stay out of the sun but most of all it is important to avoid getting sunburned.

Skin cancer can be subdivided into three separate groups:

  • Basal cell cancer
  • Squamous cell cancer
  • Melanoma

The most common of these are basal and squamous cell cancer; melanoma is rarer but is the most serious.  In fact, melanoma causes the majority of deaths resulting from skin cancer and it is called melanoma because changes in skin cell called melanocytes are the cells that cause it.  Melanocytes are also the cells that make pigment (melanin) which gives colour to the skin, eyes and hair

Treatment for Melanoma

Provided the melanoma is detected early enough then local surgery, as mentioned earlier, maybe all that is needed to remove the cancerous tissue.

If the disease has spread into nearby lymph nodes their removal will also be needed.

If cancer has spread further and invaded other organs then it becomes more difficult to treat and the five year survival rate has been shown to drop from 98% to 23%. At this point, the treatment required becomes more invasive and more unpleasant.

Treatments for melanoma at this stage may include:

  • Chemotherapy is given to target and kill the cancer cells.
  • Immunotherapy involves giving drugs that may be given alongside surgery and chemotherapy. Immunotherapy will look to boost the immune system in order to help it fight cancer.
  • Radiation treatment is used in an attempt to relieve pain or discomfort.
  • Targeted therapy drugs are given to specifically attack the cancer cells and so reduce any collateral damage sustained by normal cells. This damage is something that normal cells will suffer as a side effect of chemotherapy or radiation therapy.
  • Surgery can still be useful even if cancer has spread to other areas of the body; tumours can be removed and so reduce further spread of the disease.

Conclusion

Despite there having been some studies done that suggest a possible causal link between PDE 5 inhibitors and melanoma, nothing definitive has been established.  

There is a vague link however between the enzyme phosphodiesterase 5 (PDE 5) which these drugs block and the fact that they are mimicking the activation of a mutation which is often observed in melanoma. The enzyme known as PDE5A is regulated by something known as a BRAF gene; this gene belongs to a class of genes known as ‘oncogenes’ which are defined as genes that can sometimes cause cells to mutate into a cancer cell.

When the BRAF genes become mutated they can potentially cause normal cells to become cancer cells. When the BRAF genes are activated then the levels of PDE5A are inhibited and it is thought that this inhibition of the PDE5A enzyme causes the melanoma cells to become more invasive. Thus, drugs in the PDE5 inhibitor group are imitating the action of the mutated BRAF genes so producing a similar outcome. Potentially this would explain why an increased risk of melanoma was seen in men taking Viagra.

Alternatively, the reason could be as simple as the fact that as they are taking.

Viagra on a regular basis they are seeing their healthcare team on a more regular basis and so it is likely that they are being more regularly screened in general than men who are not taking the drug. This would suggest that the increased incidence of melanoma seen among users of Viagra was totally unrelated to the drug itself

Whatever the facts of the matter there are millions of men worldwide whose sex lives have been transformed by the ‘accidental discovery’ which brought about the drug called Viagra or sildenafil.

As with any drug or treatment, there are bound to be some negative points to take into consideration but with careful observation and monitoring by healthcare professionals, any possible risks can be minimised.

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