Early use of vitamin B3 derivative may halve recurrence after first skin cancer. Digest
Individuals with a history of skin cancer face a sustained risk of recurrence or new cancers, but clinical guidance is still vague on when to begin preventive treatment. One low-cost option, nicotinamide (a form of vitamin B3), is already used by dermatologists, yet evidence from real-world populations has been limited.
This observational study used health records from over 33,000 patients in the U.S. Veterans Affairs system who had at least one prior skin cancer. About 12,000 of them took oral nicotinamide (500 mg twice daily for at least 30 days), and were matched with over 21,000 nonusers. Researchers tracked the time until the next treated skin cancer, including two types: basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC).
The results suggest a protective effect of nicotinamide, especially when started early:
Across the full cohort, those taking nicotinamide had a 14% lower rate of new skin cancers compared with nonusers.
-
The strongest benefit appeared when nicotinamide was started after a patient's first skin cancer, cutting the rate of new skin cancers by over 50%. This protective effect weakened as the number of previous cancers increased.
You just missed this in your inbox
Every other week our Premium Members received this exact study plus Rhonda's practical commentary and 8+ other hand-picked papers.
Type-specific analysis showed no overall reduction in basal cell carcinoma, but a significant 22% decrease in cutaneous squamous cell carcinoma.
Even among patients who did not receive other preventive treatments, nicotinamide was linked to a 37% lower cancer rate.
Differences emerged early: By 30 days of nicotinamide use, users already had a lower risk of new skin cancers compared with nonusers.
These findings align with the idea that nicotinamide acts as a chemopreventive agent, meaning it may help prevent rather than treat skin cancer. Its greater effect on cSCC is consistent with past trials, and the stronger benefit with earlier use suggests that timing is key. The authors found no convincing evidence that nicotinamide increased cancer risk, which helps address prior theoretical concerns.
Although the study used a large clinical dataset and careful matching, it was observational, not a randomized trial. Moreover, the study relied on procedural billing codes to define cancer diagnoses and may have missed untreated or superficial lesions. Still, the findings support earlier use of nicotinamide in high-risk patients and provide a basis for future trials to refine its timing and use alongside other therapies. Get more information on cancer prevention and screening in this clip featuring Peter Attia, M.D.