GLP-1 Receptor Agonists Are Safe for Patients with Melanoma In Situ
Yes, a patient with a history of melanoma in situ can safely take GLP-1 receptor agonists. The absolute contraindication for GLP-1 RAs applies only to medullary thyroid carcinoma (MTC) or multiple endocrine neoplasia syndrome type 2 (MEN2), not to melanoma or other skin cancers 1.
Evidence Supporting Safety in Melanoma
The most robust evidence comes from a 2024 population-based cohort study of 11,786 GLP-1 RA users compared with 208,519 sulfonylurea users, which found no increased risk of melanoma (42.6 vs. 43.9 per 100,000 person-years; HR 0.96,95% CI 0.53-1.75) 2. This study specifically examined melanoma as a separate outcome and found no association even with cumulative duration of use 2.
A 2019 meta-analysis of 50,452 patients across 34 randomized controlled trials confirmed no increase in malignant neoplasm formation with GLP-1 RAs (OR 1.04,95% CI 0.94-1.15) 3. Furthermore, a 2024 study examining 13 obesity-associated cancers in 1.65 million patients with type 2 diabetes found that GLP-1 RAs were not associated with increased cancer risk and actually showed protective effects for multiple cancer types 4.
Specific Contraindications to Verify
Before prescribing, screen for the actual contraindications 1, 5:
- Personal or family history of medullary thyroid carcinoma (absolute contraindication)
- Multiple endocrine neoplasia syndrome type 2 (absolute contraindication)
- Severe hypersensitivity reaction to the specific GLP-1 RA (absolute contraindication)
Melanoma in situ does not appear on any contraindication list for GLP-1 receptor agonists 5, 6.
Clinical Algorithm for This Patient
For a patient with melanoma in situ history:
- Confirm the melanoma diagnosis was in situ (not invasive) and has been completely excised
- Screen for MTC/MEN2 contraindications (personal or family history) 1, 5
- Proceed with standard GLP-1 RA prescribing if no contraindications exist 5
- Follow routine dermatologic surveillance for melanoma recurrence per standard guidelines (not related to GLP-1 RA use) 5
- Monitor for actual GLP-1 RA safety concerns: gastrointestinal effects, gallbladder disease, pancreatitis, and tachycardia 1
Medication Selection
Choose the GLP-1 RA based on clinical indication, not melanoma history 1, 5:
- For type 2 diabetes with obesity: Tirzepatide 15mg weekly achieves 20.9% weight loss 1
- For established cardiovascular disease: Semaglutide 2.4mg weekly provides 26% reduction in CV death/MI/stroke (HR 0.74) 1, 5
- For obesity without diabetes: Semaglutide 2.4mg weekly achieves 14.9% weight loss with proven CV benefit 1, 7
Common Pitfall to Avoid
Do not unnecessarily withhold GLP-1 RAs based on melanoma history. The FDA Black Box Warning specifically addresses thyroid C-cell tumors (medullary thyroid carcinoma), not melanoma or other skin cancers 5. Major cardiovascular guidelines do not identify melanoma or other non-MTC cancers as safety concerns with GLP-1 RA therapy 5.