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Findings in a well-established, long-term cohort study suggest a positive association between PDE5A inhibitor (sildenafil) use for ED and risk of subsequent melanoma. Our study cannot prove cause and effect. A longer follow-up and more detailed assessment of the dose and frequency of sildenafil use at multiple times in the HPFS would be necessary for future studies. We also plan to work on clinical databases to examine this association. Further studies are needed to confirm our findings in other populations, particularly in a dose-dependent manner, and to investigate underlying biological mechanisms. It would also be very important to examine the possible latency of exposure to PDE5A inhibitor (sildenafil) use and melanoma risk. Our results should be interpreted cautiously and are insufficient to alter current clinical recommendations. Nevertheless, our data provide epidemiological evidence on possible skin adverse effects of PDE5A inhibitors and support continued investigation of this relationship.

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