Large study confirms preventative benefits of nicotinamide in BCC, SCC

Dr. Lee Wheless, photo courtesy Vanderbilt University Medical Centre

Dermatologists have recommended the dietary supplement nicotinamide for people with a history of skin cancer since 2015, when a clinical study with 386 participants showed that those who took the vitamin B3 derivative developed fewer new occurrences.

However, data to validate those findings in a larger study group have been lacking because nicotinamide can be purchased over the counter without being entered into patients’ medical records.

In a new study published Sept. 17 in JAMA Dermatology, researchers found a way to collect that data by analyzing records from the U.S. Veterans Affairs Corporate Data Warehouse. Nicotinamide is on the Veterans Affairs’ official formulary, so the researchers checked the outcomes of 33,833 patients for their subsequent skin cancer diagnosis. They looked for occurrences of basal cell carcinoma and cutaneous squamous cell carcinoma.

The researchers compared 12,287 patients who received treatment with 500 milligrams of nicotinamide twice daily for longer than 30 days with 21,479 who did not receive nicotinamide treatment. Overall, there was a 14% reduction in skin cancer risk. When nicotinamide was taken after a first skin cancer, the risk reduction rose to 54%, but the benefit declined with treatment initiation following subsequent skin cancers. The risk reduction was much larger for squamous cell carcinoma.

“There are no guidelines for when to start treatment with nicotinamide for skin cancer prevention in the general population. These results would really shift our practice from starting it once patients have developed numerous skin cancers to starting it earlier. We still need to do a better job of identifying who will actually benefit, as roughly only half of patients will develop multiple skin cancers,” said the study’s corresponding author, Lee Wheless, MD, PhD, in a press release. Dr. Wheless is an assistant professor of Dermatology and Medicine at Vanderbilt University Medical Center and a staff physician at VA Tennessee Valley Healthcare System.

The researchers were also able to ascertain the outcomes of 1,334 patients who were immunocompromised due to having received solid organ transplants. Among solid organ transplant recipients, no overall significant risk reduction was observed, although early nicotinamide use was associated with reduced occurrences of cutaneous squamous cell carcinoma.

Dr. Wheless received research support from a Department of Veterans Affairs grant (IK2CX002452).