Harnessing Nicotinamide: A Strategy to Combat Skin Cancer Recurrence

Skin cancer recurrence poses a continued threat even after the first diagnosis. Preventing new lesions remains a priority; nicotinamide is gaining attention as an accessible, low-cost option.

For patients and clinicians, vigilance after initial treatment often shifts to prevention—raising the question of how adjuncts like nicotinamide might help.

Nicotinamide has been shown in preclinical and small human studies to support DNA repair pathways and cellular energy metabolism, which may help reduce ultraviolet radiation–related immunosuppression.

Recent studies, including a Veterans Affairs cohort analysis, suggest that nicotinamide can reduce the risk of subsequent non-melanoma skin cancers during active supplementation, though major guidelines have not universally endorsed routine use and generally consider it for high-risk patients.

These recent studies point toward an evidence-supported chemopreventive option that reduces the incidence of new non-melanoma skin cancers during supplementation, as reflected in outcomes reported in the VA study on nicotinamide and skin cancer incidence during supplementation.

Such findings are influencing how some clinicians consider daily nicotinamide—particularly for high-risk patients—to address recurrence.

For patients previously diagnosed with basal cell carcinoma, nicotinamide can modestly reduce the risk of subsequent lesions during active supplementation. However, not all patient groups benefit equally; evidence is mixed, and some trials in solid organ transplant recipients have not demonstrated significant reductions with nicotinamide.

While current practice centers on oral dosing, research into topical formulations and optimized regimens is emerging.

Future studies should clarify which patients benefit most and inform eligibility criteria. The next step is to clarify eligibility through comparative trials and real-world studies, weighing benefits, adherence, and cost.

Key Takeaways:

• Nicotinamide has been shown to reduce the incidence of new non-melanoma skin cancers during active supplementation, with use often considered for high-risk patients rather than universally recommended.
• Mechanistically, nicotinamide may support DNA repair and cellular energy pathways, helping counter UV-related immunosuppression, though definitive in vivo proof is limited.
• Patient selection matters: benefits appear modest on average and may be inconsistent in certain groups such as solid organ transplant recipients.