From the Guidelines
Niacinamide has been shown to be a promising agent in the prevention of skin cancer, particularly in high-risk individuals, with oral nicotinamide reducing the risk for subsequent keratinocyte carcinoma in nonimmunosuppressed individuals with a history of such carcinomas 1.
Key Findings
- The evidence for topical and oral agents in reducing the risk for new skin cancers is mixed, but oral nicotinamide has shown promise in reducing the risk for subsequent keratinocyte carcinoma 1.
- Topical retinoids have not been found to reduce the incidence of keratinocyte cancers, and their use for prolonged periods may be associated with increased mortality 1.
- Other agents, including cyclic PDT, celecoxib, and dietary supplements like β-carotene and selenium, have limited evidence or significant risks associated with their use 1.
Recommendations
- For individuals with a history of skin cancer, particularly non-melanoma skin cancers, oral nicotinamide may be considered as part of a comprehensive prevention plan, with a dosage of 500-1000mg daily 1.
- Niacinamide should complement, not replace, primary prevention strategies like sun protection (broad-spectrum sunscreen, protective clothing, avoiding peak sun hours) and regular skin checks.
- Patients with a history of skin cancer should be counseled regarding the risk for new primary skin cancers, the need for in-office screening, and the potential benefits of self-screening and sun protection 1.
Important Considerations
- Niacinamide is not a replacement for standard treatments for established skin cancers, and individuals with existing skin cancers should consult a dermatologist for proper treatment.
- Most people tolerate niacinamide well with minimal side effects, making it a reasonable addition to a comprehensive skin cancer prevention plan.
From the Research
Role of Niacinamide in Skin Cancer Prevention
- Niacinamide, a derivative of niacin, has been studied for its potential role in preventing skin cancer, including non-melanoma skin cancers (NMSC) such as basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) 2, 3, 4, 5, 6.
- Research suggests that niacinamide may have a beneficial role in reducing the risk of SCC, with one study finding an inverse association between total niacin intake and SCC risk 3.
- However, the evidence for its role in preventing BCC and melanoma is less clear, with some studies suggesting a potential positive association between niacin intake and BCC risk 3.
- Nicotinamide, the active form of vitamin B3, has been shown to enhance DNA repair, prevent ultraviolet (UV)-induced immunosuppression, and support energy-dependent cellular processes, including DNA repair 4, 5, 6.
- Oral nicotinamide therapy has been found to reduce the incidence of actinic keratoses and NMSC in high-risk individuals, making it a potential option for skin cancer chemoprevention 2, 5.
Mechanisms of Action
- Nicotinamide's anti-carcinogenic role may be due to its ability to enhance DNA repair and prevent UV-induced immunosuppression 4, 5.
- It also plays a significant role in supporting energy-dependent cellular processes, including DNA repair, by serving as a precursor to essential coenzymes such as nicotinamide adenine dinucleotide (NAD) 4, 6.
- Nicotinamide has been shown to modulate inflammatory cytokine production, skin barrier function, and restore cellular energy levels after UV exposure 5.