The B3 Breakthrough: Understanding the Research

The study, published September 17 in JAMA Dermatology, tracked 33,822 veterans who received treatment for skin cancer. Researchers compared 12,287 patients who took 500mg of nicotinamide twice daily for more than 30 days against 21,479 who didn’t take the supplement.

The results? An overall 14% reduction in skin cancer risk. But the real eye-opener came when analyzing patients who started taking nicotinamide right after their first skin cancer diagnosis—these folks saw their risk drop by 54%.

The timing of intervention proved crucial. The protective effect was strongest when nicotinamide treatment began immediately after a first diagnosis, with diminishing returns after multiple skin cancers had already developed.

“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, assistant professor of Dermatology and Medicine at Vanderbilt University Medical Center and a staff physician at VA Tennessee Valley Healthcare System.

How Nicotinamide Protects Your Skin

Nicotinamide helps protect cells from UV radiation damage. The supplement specifically targets non-melanoma skin cancers—basal cell carcinoma and cutaneous squamous cell carcinoma—with the strongest protection observed against squamous cell carcinomas.

Not Just Any B3: Understanding the Difference

It’s important to note that patients should look specifically for nicotinamide (also called niacinamide), not niacin. While both are forms of vitamin B3, they don’t have the same effects. For background on randomized trials, see the phase 3 ONTRAC study in the New England Journal of Medicine.

Dr. Sarah Arron, a San Francisco Bay area dermatologist not involved in the study, notes in an editorial accompanying the research that the supplement is widely available over the counter and has minimal adverse effects.

Who Should Consider Nicotinamide Supplementation?

The findings primarily benefit people who have already had skin cancer. For those diagnosed with their first skin cancer, starting nicotinamide early appears to offer substantial protection against recurrence.

The study also examined 1,334 immunocompromised patients who had received solid organ transplants. While this group didn’t see an overall significant risk reduction, early nicotinamide use was associated with fewer squamous cell carcinomas.

Whether the supplement benefits those who’ve never had skin cancer remains an open question requiring further research. “It is certainly possible that somebody who is at higher risk for skin cancer, who’s already showing signs of precancerous change in the skin, might benefit from nicotinamide,” says Dr. Arron. “But we’ll have to do those studies to see.”

Still Need Your Sunscreen: Comprehensive Protection

Researchers emphasize that nicotinamide supplements don’t replace traditional prevention strategies like sunscreen, protective clothing, and regular skin checks. The vitamin works best as an additional layer of protection, especially for those already facing the challenging cycle of skin cancer recurrence.

With more than $8.9 billion spent annually on skin cancer treatment in the U.S., this inexpensive supplement offers a practical approach to reducing both the medical and personal burden of repeated skin cancers.

The study was supported by a Department of Veterans Affairs grant (IK2CX002452).