NF1 Associated with More Cancer Types Than Previously Known

Common Supplement Shows Greater Skin Cancer Prevention When Started Early

In a large retrospective study of veterans, the B3 derivative nicotinamide was found to be effective at reducing the risk of squamous cell carcinoma.

Patients who started taking a common supplement after their first skin cancer diagnosis cut their risk of developing another cancer by more than half, according to the largest study to date on the over-the-counter product.

The study, published recently in JAMA Dermatology, followed more than 33,000 veterans and found that patients who started the B3 derivative nicotinamide after their first skin cancer saw their risk drop by 54%. The findings suggest that timing is key: starting early offers the strongest protection, while waiting until multiple cancers have developed sharply reduces the benefit.

Led by Lee Wheless, M.D., Ph.D., an assistant professor of dermatology at Vanderbilt University Medical Center, the study provides guidance on when to use a supplement that roughly 75% of dermatologic surgeons already recommend for prevention. The findings suggest that starting nicotinamide early in a patient's skin cancer journey is key to maximizing its protective benefits.

"The results of this cohort study suggest that there is a decreased risk of skin cancer among patients treated with nicotinamide, with the greatest effect seen when initiated after the first skin cancer," the study authors wrote.

Nicotinamide, typically taken as 500 milligrams twice daily, helps cells repair damage caused by sunlight, reducing the risk of both basal cell carcinoma and squamous cell carcinoma. The supplement has gained attention as a safe prevention option, particularly for people at high risk of repeat skin cancers. Previous studies were smaller and sometimes inconclusive, but this research provides the most comprehensive evidence to date.

This study matched nearly 12,300 veterans taking nicotinamide with approximately 21,500 similar patients not taking the supplement, tracking them over several years to measure new skin cancer development. Across the full group, nicotinamide users had about a 14% lower risk of developing new skin cancers. The supplement was most effective against squamous cell carcinoma, reducing risk by about 20% overall.

Among patients who had developed only one or two prior skin cancers, the protective effects remained strong, with risk reductions close to the 50% level seen in those who started after their first cancer. Patients who waited until after their seventh skin cancer to start nicotinamide saw virtually no benefit from the supplement.

The timing findings align with how skin cancer risk accelerates after each diagnosis. Previous research has shown that once patients develop their first skin cancer, the rates of subsequent cancers increase with each new diagnosis, creating a window where early intervention could be most beneficial.

Solid organ transplant recipients, who face elevated skin cancer risk due to immunosuppressive medications, saw more limited benefits from nicotinamide in this study. However, transplant patients with only one or two prior skin cancers still experienced a 53% reduction in cutaneous squamous cell carcinoma risk when taking the supplement.

The study also showed that patients taking nicotinamide from a month to a year experienced similar protective benefits, suggesting that long-term supplementation may not be necessary for some patients. Most participants had been exposed to other skin cancer prevention treatments, including topical therapies and photodynamic therapy, but nicotinamide showed additional protective effects even after accounting for these interventions.

Because the study was observational and relied on veterans' health records, the authors cautioned that the findings may not apply equally to women or younger patients, and a randomized clinical trial is still needed.

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This Cheap Supplement Can Prevent Skin Cancer From Returning: Study

Your daily SPF just got backup in the battle against skin cancer.

New research suggests a cheap, over-the-counter supplement may help protect against the disease — with benefits showing up in as little as a month.

Better yet, scientists found the vitamin cuts the risk of recurrence by more than half in people who have previously received a positive diagnosis.

The number of non-melanoma skin cancers in the US has been increasing in recent years. Doodeez – stock.Adobe.Com

The findings back up what dermatologists have been telling skin cancer survivors for a decade — take nicotinamide, a form of vitamin B3.

The advice stems from a 2015 clinical trial of 386 patients, which found fewer new skin cancers in those taking the supplement.

But verifying those results on a larger scale has been difficult, since nicotinamide can be purchased without a prescription, leaving no record in patients' medical files.

To get around this, researchers tapped the Veterans Affairs Corporate Data Warehouse, where nicotinamide use is officially tracked.

They compared more than 12,000 patients taking 500 mg twice daily for at least a month with over 21,000 who didn't.

Their focus: cases of basal cell carcinoma and cutaneous squamous cell carcinoma — two common types of non-melanoma skin cancer.

Nicotinamide is a form of vitamin V found in food and used as a dietary supplement. Nicotinamide Resveratrol

The researchers found that, on average, patients taking nicotinamide had a 14% lower risk of developing skin cancer compared to those who didn't.

"The greatest impact was seen in squamous cell carcinoma, where risk dropped by more than 20%," Dr. Yousuf Mohammed, research leader at the Frazer Institute, University of Queensland, who wasn't involved in the study, said in a statement.

But the real headline? For those with a history of skin cancer, starting the supplement after their first case slashed the risk of recurrence by a whopping 54%.

That protective effect, however, declined sharply for those who had already battled multiple bouts of skin cancer before taking nicotinamide.

"There are no guidelines for when to start treatment with nicotinamide for skin cancer prevention in the general population," Dr. Lee Wheless, assistant professor of Dermatology and Medicine at Vanderbilt University Medical Center and corresponding author of the study, said in a press release. 

"These results would really shift our practice from starting it once patients have developed numerous skin cancers to starting it earlier," he added. 

The supplement works best at preventing skin cancer recurrence when started after the first diagnosis. Anna Zhosanova – stock.Adobe.Com

Scientists are still figuring out exactly how nicotinamide fights skin cancer, but past research shows it helps cells repair DNA damaged by UV rays and dulls some of the immune-suppressing effects of sunlight.

"I am going to be more rigorous in recommending it to patients, especially patients who are having their first skin cancer," Sarah Arron, a dermatologist, told NPR. "I think the benefit is strongest if we start it early."

When buying the supplement, she recommends choosing the form that ends with "amide" — nicotinamide — rather than niacin (nicotinic acid), another type of vitamin B3 that doesn't offer the same benefits.

Generally, nicotinamide is well-tolerated at normal doses. Side effects, if any, tend to be mild, such as nausea, diarrhea, headaches or fatigue.

"For clinicians, the appeal of nicotinamide lies in its accessibility, safety and tolerability," Mohammed said. 

Because this study looked at veterans' health records, the authors warned that the findings might not apply to women or younger people, and said a randomized clinical trial is still needed to confirm the results.

Each year, 5.4 million basal and squamous cell skin cancers are diagnosed in the US, and cases are rising, according to the American Cancer Society.

While nicotinamide may be a handy new weapon against skin cancer, experts say it's no excuse to skip sunscreen and other sun-smart habits.

Daily Vitamin B3 Dose Cuts Skin Cancer Risk By Up To 54%

A common, over-the-counter form of vitamin B3 has emerged as an inexpensive ally in protecting us from skin cancer, lowering the risk by an average of 14% and increasing to a massive 54% for anyone who has previously had a positive diagnosis. This latest study of more than 33,000 patients supports earlier evidence that emerged in a 2015 Australian trial.

Researchers from Vanderbilt University Medical Center conducted a large real-world analysis of US veterans, which looked at the health records of 33,822 individuals, comparing those prescribed niacinamide (typically 500 mg twice daily for more than 30 days) with matched patients who didn't take it.

Overall, niacinamide – also known as nicotinamide, a vitamin B3 form found in food and supplements that supports cellular energy, DNA repair and healthy skin – was associated with a 14% lower risk of developing skin cancer. When people began nicotinamide after having earlier received a positive skin cancer diagnosis, the reduction in risk was 54%. What's more, the effect was seen in both basal cell carcinoma and cutaneous squamous cell carcinoma, with the largest drop in squamous cell cancers.

"There are no guidelines for when to start treatment with nicotinamide for skin cancer prevention in the general population," said corresponding author Lee Wheless, M.D., assistant professor of Dermatology and Medicine at Vanderbilt University Medical Center. "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."

While basal cell carcinoma, which generally affects areas of the skin that have endured longterm exposure to the Sun, develops slowly, they can be easily missed for some time and surgery can be significant. (In 2024, I had surgery to remove one measuring 0.4 cm in diameter, which required a deep and wide excision, and around 20 subcutaneous and surface stitches.) Cutaneous squamous cell carcinoma, meanwhile, are cancerous growths on a more surface layer of skin. These, along with melanoma, make up the three malignant skin cancers.

People tend to underestimate the impact and seriousness of non-melanoma cancers. The US spends more than US$8 billion each year in treating skin cancer – and a majority of that cost ($4.8 billion) is to address non-melanoma types.

In general, niacinamide has been shown to help skin cells repair UV-induced DNA damage, and it blunts some of the immunosuppressive effects of sunlight. While observational, so causation can't be proven, this study is by far the biggest dataset yet on niacinamide's everyday performance outside of controlled clinical trials. The veteran cohort also skews older and male (average age 77 and predominantly white men), and the researchers caution that studies on a more diverse demographic are needed to see if these results can be replicated more broadly.

However, it does echo the findings of the groundbreaking 2015 ONTRAC phase-3 trial in Australia, which demonstrated that 500 mg of niacinamide twice daily lowered the incidence of new non-melanoma skin cancers by about 23% over 12 months in 386 high-risk adults with prior skin cancers. And this protective factor diminished once the individuals discontinued the treatment.

While the researchers urge that this is no replacement for covering up and applying sunscreen to exposed skin, for people who've had a first basal or squamous cell carcinoma removed, a daily niacinamide regimen is emerging as a practical, inexpensive way to lower the odds of a recurrence. And this study gives clinicians and patients more real-world numbers to weigh when deciding whether these supplements could be of benefit.

"The results of this cohort study suggest that there is a decreased risk of skin cancer among patients treated with nicotinamide, with the greatest effect seen when initiated after the first skin cancer," noted the researchers.

"Nicotinamide, a simple vitamin B3 derivative, is showing real promise as a practical tool for skin cancer prevention," said Dr Yousuf Mohammed, a Senior Research Fellow at the University of Queensland. "These findings highlight that timing matters; starting earlier may be the key to stronger protection. For clinicians, the appeal of nicotinamide lies in its accessibility, safety, and tolerability. Unlike systemic retinoids or invasive field therapies, nicotinamide is inexpensive, over-the-counter, and free from significant side effects.

"Overall, these results reinforce what many dermatologists have long suspected, nicotinamide is an underutilized, low-risk intervention that can make a difference in reducing skin cancer burden, especially for patients with an early history of disease," he added.

The research was published in the journal JAMA Dermatology.

Source: Vanderbilt University Medical Center

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