06 Oct Vanderbilt Study Analyzes Effect of Nicotinamide on Skin Cancer Prevention
MedicalResearch.com Interview with:
Dr. Wheless
Lee Wheless, MD, PhD
Assistant Professor
Department of Dermatology
Department of Medicine, Division of Epidemiology
Vanderbilt University Medical Center
Staff Physician
Tennessee Valley Health System VA Medical Center
MedicalResearch.com: What is the background for this study?
Response: Nicotinamide has been in use for skin cancer prevention for at least a decade. A more recent trial among solid organ transplant recipients (SOTR) specifically concluded that there was no benefit in this population. While that study had a number of issues, it really led dermatologists to question whether it was efficacious. This coupled with another study around the same time that suggested that metabolites of nicotinamide might increase the risk of major adverse cardiovascular events (MACE).
My group earlier this year conducted a similar study to this one showing that we really did not observe any increase in MACE at the population level. We then turned to address of the question of if nicotinamide was actually useful in reducing skin cancer risk.
MedicalResearch.com: What types of skin cancers were measured? Did the findings apply to non or immunocompromised patients or both?
Response: In this study, we considered three different outcomes:
- 1) Skin cancer overall,
- 2) Basal cell carcinoma (BCC), and
- 3) Cutaneous squamous cell carcinoma (cSCC). We used a validated algorithm to capture these individually.
The majority of the patients included were not immunosuppressed, although we did have a fair number of patients with solid organ transplants or chronic lymphocytic leukemia. We had nowhere near the power to do the stratified analyses among these subgroups, so we couldn’t draw all the same conclusions among them as we could in the overall population.
MedicalResearch.com: What are the main findings?
Response: First, we did observe a 14% decreased risk of skin cancer among patients exposed to nicotinamide compared to the unexposed group. Interestingly, the benefit was greatest among those who started nicotinamide after only one skin cancer, while there was a steady decay of effect with each subsequent skin cancer prior to nicotinamide initiation such that after 7 skin cancers, we no longer observed any effect.
The benefit existed for both BCC and cSCC, with a stronger protective affect against cSCC. While we had low power to detect differences among SOTR, we did observe a benefit among this group for cSCC.
MedicalResearch.com: What should readers take away from your report?
Response: We don’t have formal recommendations for when to start nicotinamide in the general population, but in general we tend to start nicotinamide once a patient has declared themselves to be a ‘super-producer’ with numerous skin cancers. While this was an observational study that really needs to be replicated prospectively, these results should make us rethink delaying treatment. I’m certainly not suggesting that every skin cancer patient be on nicotinamide. But for those patients where your clinical judgement just tells you this patient is going to get a lot of skin cancers, I would consider starting nicotinamide sooner rather than later.
MedicalResearch.com: What recommendations do you have for future research as a results of this study?
Response: There are two main directions that we would need to take.
First, as I mentioned we need to look at this prospectively. An observational design has a lot of drawbacks, and while we did a pretty good job controlling for the baseline risk of skin cancer by matching on both the number and timing of skin cancers plus other exposures, the fact remains that we had to impute the baseline date for our unexposed patients. Having a definite date of indication and measuring with histologically-verified skin cancers will really provide the best possible data as to the effectiveness of nicotinamide.
Second, we need to do research to identify the super-producers earlier to guide intervention. Earlier this year I collaborated with Drs. Rebecca Hartman (co-senior author with me on this study) and Mackenzie Wehner to combine 5 different datasets and include records for up to 5.5 million skin cancer patients. We saw that only 43% of patients overall were treated for a second skin cancer during the study interval, and most of those were within 2 years of the first. What this means is that while we saw the greatest benefit of nicotinamide when started after the first skin cancer, we’re looking at ~60% of patients who might not actually be getting any kind of benefit if we started everyone on it after their first skin cancer.
In that same study, we found that only 3% of patients contributed a whopping 22% of the total number of skin cancers. What this means is that here is a real opportunity for precision medicine and skin cancer prevention if we can find biomarkers or other clinical indicators of risk for multiple skin cancer development.
Disclosures: I receive support from VA CSR&D CX-002452
Citation:
Breglio KFKnox KMHwang J, et al. Nicotinamide for Skin Cancer Chemoprevention. JAMA Dermatol. Published online September 17, 2025. doi:10.1001/jamadermatol.2025.3238
https://jamanetwork.com/journals/jamadermatology/article-abstract/2838591
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Last Updated on October 6, 2025 by Marie Benz MD FAAD
