Preventing Melanoma: Should You Drink More Coffee and Hold Off on the Viagra?

Suraj Venna, MD, is board certified in dermatology. He is the founding director of the Inova Melanoma and Skin Cancer Center. Dr. Venna specializes in detecting and treating skin cancer. Dr. Venna is also chair for the 2015 American Society of Clinical Oncology Melanoma Education Committee, the largest international meeting of oncologists. Read Dr. Venna’s profile.

In the past five years, there has been an unprecedented pace of discovery and drug approval for treating metastatic melanoma. For example, we’ve learned that more than 50 percent of melanomas have changes, or mutations, in the BRAF gene. The mutated BRAF protein causes the cancer cells to grow rapidly. Based on this discovery, we have developed therapies to target the BRAF protein and slow the growth of melanoma.

Advances in Immunotherapy for Melanoma

The other approach in treating advanced melanoma is to enhance the responsiveness of the patient’s immune system, called immunotherapy. We treat the immune system rather than treating the melanoma. At the June 2015 meeting of the American Society of Clinical Oncology, we saw results from the first Phase III trial that evaluated the combination of immunotherapies (anti CTLA4 and anti PD1 agents). The results showed unprecedented responses that are now undergoing further study. This is fantastic progress!

However, if we would institute immunotherapy as a standard treatment, it would cost approximately $300,000 per patient. More importantly, trials have not yet demonstrated a survival advantage. We do anticipate that we will see a true survival benefit and cures in the longer run. Fortunately, most people who develop melanoma present with skin-limited melanoma and not advanced melanoma that has spread to internal organs.

 Melanoma: Less Viagra, More Coffee

Catching melanoma at an early stage and removing it still leads to the best overall chances of beating this potentially fatal disease. One of our primary goals is to develop effective strategies to screen and prevent melanoma.

Three recent studies have garnered a lot of media attention, focusing on the effects of erectile dysfunction medication and coffee intake on melanoma development:

• Two papers suggested an increased risk of melanoma for those taking medications for erectile dysfunction (ED), such as Viagra®, Cialis and Levitra.
• One paper suggested that coffee intake may have a protective effect—that it may, in fact, reduce the risk of melanoma.

ED Drugs and Melanoma

In laboratory studies, we found that the mechanism of ED drugs overlaps with a pathway that is abnormal in melanomas:

• The 2014 study suggests an association between Viagra and melanoma. However, the study did not prove cause and effect since the absolute cases of melanoma was small. This study also found an increased risk of melanoma among married men and those with a higher education level.

• The 2015 study compared all three ED medications but did not find a significant difference in melanoma development. The caveat is that it did show a weak correlation for early melanoma but not for thicker melanomas.

We would need to see further studies with dosing before we make recommendations to change current practices. But if you use ED medications, it is prudent to discuss it as part of your medical history when seeing your doctor.

Coffee and Melanoma

There are few studies linking diet and melanoma. A recent study looked at a large U.S. cohort to determine the association between coffee intake and melanoma. As it turns out, coffee has many bioactive compounds that can:

• Protect against sun damage
• Protect against DNA damage and oxidative stress (the damage caused from the interactions of free radicals with other molecules in our body. Free radicals are the result of our constant reactions with the oxygen we need to breathe and produce energy).
• Reduce inflammation

This study linked higher coffee intake to a modest decrease in risk of melanoma: Coffee drinkers versus non-drinkers had 20 percent lower risk of melanoma. In this study the 20 percent reduction was in those who drank four or more cups of caffeinated coffee per day!

Is More Coffee the Answer?

I would say these are intriguing preliminary findings that warrant further study. High amounts of caffeine can have serious detrimental effects to your physiology, so we cannot advocate that you start increasing daily coffee intake to this extreme. There are so many dietary and behavioral factors related to cancer growth that are difficult to tease apart. This is why it is important to talk to your doctor, who can help figure out the best melanoma prevention and treatment plan for you.