Retinol Is Not Recommended for Basal Cell Carcinoma Prevention
Oral retinol should not be used to prevent basal cell carcinoma (BCC), as high-quality evidence demonstrates no protective benefit and current guidelines explicitly recommend against its use. 1
Guideline Recommendations
The American Academy of Dermatology (AAD) 2018 guidelines provide the most authoritative and recent evidence on this topic:
The use of oral retinol is not recommended to reduce the incidence of future BCCs in patients with a history of BCC (Strength of Recommendation: A, Level of Evidence: I). 1
This recommendation applies equally to other retinoids including tretinoin, acitretin, and isotretinoin—none are recommended for BCC prevention. 1
The AAD guidelines explicitly state that topical and oral retinoids are not recommended for reducing risk for subsequent BCC in patients with a history of BCC. 2
Supporting Evidence
High-Risk Population Studies
The strongest evidence comes from a randomized, double-blind, placebo-controlled trial in high-risk patients:
In patients with a history of at least four prior skin cancers, daily oral retinol (25,000 IU) showed no beneficial effect on BCC prevention over 3 years. 3
The hazard ratio for first new BCC in retinol-supplemented subjects compared to placebo was 1.06 (95% CI: 0.86-1.32; P = 0.36), indicating no protective effect. 4
Moderate-Risk Population Studies
Even in moderate-risk subjects (those with >10 actinic keratoses and ≤2 prior skin cancers), retinol supplementation showed no effect on BCC incidence despite reducing squamous cell carcinoma risk. 4, 5
This differential effect is important: retinol may reduce squamous cell carcinoma but does not prevent BCC. 4, 5
Recent Genetic Evidence
- A 2024 Mendelian randomization study found no causal relationship between circulating retinol levels and BCC risk (OR = 1.04 [0.96,1.12], P = 0.38). 6
Important Distinctions
What Retinol Does NOT Do for BCC:
- Does not prevent first occurrence of BCC 4, 3
- Does not prevent recurrent BCC in high-risk patients 3
- Does not reduce BCC incidence in moderate-risk patients 4
Historical Context vs. Current Evidence:
While older NCCN 2010 guidelines mentioned that oral retinoids "have been effective in reducing the development of precancers and skin cancers in some high-risk patients," 1 this statement was not specific to BCC and predates the definitive 2018 AAD guidelines that explicitly recommend against retinol use for BCC prevention based on Level I evidence. 1
What Actually Works for BCC Prevention
Instead of retinol, focus on evidence-based strategies:
Annual skin cancer screening for patients with a history of BCC (Strength A, Level I evidence). 1
Sun protection measures: broad-spectrum sunscreen, sun avoidance during peak hours (10 AM-4 PM), protective clothing, and wide-brimmed hats. 1, 2
Skin self-examination with family assistance for hard-to-see areas. 1, 2
Complete avoidance of tanning beds and sunlamps, which are classified as carcinogenic. 2
Critical Pitfalls to Avoid
Do not prescribe retinol based on its effectiveness for squamous cell carcinoma prevention—the evidence clearly shows this benefit does not extend to BCC. 4, 5
Do not rely on older guidelines or anecdotal experience—the 2018 AAD guidelines with Level I evidence supersede earlier recommendations. 1
Avoid recommending other ineffective supplements such as selenium or β-carotene, which also have no proven benefit for BCC prevention. 1, 2