Intro
Nicotinamide — a form of vitamin B3 (niacinamide) — has been studied as a way to prevent nonmelanoma skin cancers. A new JAMA Dermatology study of 33,822 U.S. veterans suggests it can lower the risk of basal cell carcinoma and cutaneous squamous cell carcinoma, especially when started soon after a first skin cancer.
Key Points
- Nicotinamide 500 mg twice daily was linked to a 14% overall reduction in skin cancer risk.
- Starting nicotinamide after a first skin cancer → risk reduction of 54%.
- Greatest effect seen in cutaneous squamous cell carcinoma (cSCC).
- No significant overall benefit in solid organ transplant recipients (some signal for early use in cSCC).
- Builds on ONTRAC (NEJM 2015) with large, real-world validation.
Background
Nonmelanoma skin cancers — basal cell carcinoma (BCC) and cSCC — are the most common cancers in fair-skinned populations. Preventing recurrences is a major clinical need. Earlier trials suggested nicotinamide could help; this new retrospective cohort leveraged VA data (1999–2024) to evaluate outcomes at scale.
Causes or Mechanisms
Nicotinamide is thought to:
- Boost DNA repair after UV damage
- Reduce inflammation that fosters carcinogenesis
- Support skin immune responses
Diagnosis / Treatment / Options
- Dose studied: 500 mg orally, twice daily, >30 days.
- Use case: Secondary prevention after a first nonmelanoma skin cancer; discuss duration and monitoring with your clinician.
- Not a substitute for: Sunscreen, protective clothing, shade, or routine dermatology checks.
- Special populations: Transplant recipients/immunosuppressed may see less benefit; individualized care is essential.
Risks / Benefits / Prognosis
- Benefits: Inexpensive, widely available, generally well-tolerated; meaningful risk reduction, strongest with early initiation.
- Risks: Nicotinamide typically lacks the flushing seen with niacin; still discuss interactions and kidney/liver history with a clinician.
- Prognosis: Early adoption after the first cancer is associated with the largest risk reduction.
FAQ
Q: Who should consider nicotinamide?
A: People with prior BCC or cSCC, especially after their first tumor.
Q: Is nicotinamide the same as niacin?
A: No. Nicotinamide (niacinamide) does not cause flushing; do not substitute high-dose niacin.
Q: Does it prevent melanoma?
A: Evidence is limited; current signal is for BCC and cSCC.
Q: How long should I take it?
A: Duration isn’t standardized; clinicians often reassess at 12 months alongside skin exam frequency and recurrence history.
Q: Any side effects?
A: Generally mild; discuss with your clinician if you have kidney/liver disease or are on interacting meds.
Medical information is for education only and not a substitute for professional advice.