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The possible differences in health status and lifestyle practices between sildenafil users and nonusers may have confounded our findings. Sildenafil use was correlated with factors that may increase melanoma diagnosis, such as more severe or blistering sunburns and more physical examinations. In contrast, users tended to have less exposure to sunlight in adulthood, which may have decreased melanoma risk. Because melanoma and nonmelanoma skin cancer share major risk factors, we sought to address the concern about residual confounding by examining the association of sildenafil use with nonmelanoma skin cancer. Sildenafil use was associated exclusively with melanoma, indicating that our findings were less likely due to sun exposure, physical examinations, or detection bias. The homogeneity of the cohort decreases the misclassification of work-related sun exposures or health awareness. Erectile function itself was not associated with melanoma either. Together, these results suggest an association between sildenafil use and melanoma, regardless of other characteristics. Even so, from findings in an observational study, we cannot rule out the possibility of residual confounding by unmeasured or imperfectly measured confounders.54 users found this comment helpful. Did you? Yes No Report as inappropriate

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