HealthCert Blog

A colleague recently queried about the use of Nicotinamide in the prevention of non-melanoma skin cancers (or, as we should really be referring to them now, keratinocyte cancers [KC]).

To answer this question it is best to turn to the most up to date synthesis of available research evidence. Here is the Cancer Council wiki and this is the direct quote that responds to the colleague’s query:

Nicotinamide may be a useful chemo-preventive adjunct to sun protection and sunscreen use in high risk, immune-competent individuals with a history of multiple keratinocyte cancers.

It should not be recommended for lower-risk individuals without a history of skin cancer.

And, here is the explanatory note:

Nicotinamide is an amide form of vitamin B3 which enhances DNA repair after ultraviolet (UV) irradiation, and reduces the immune suppressive effects of sunlight on the skin.^[22]

Oral nicotinamide reduced numbers of actinic (solar) keratoses (AKs) in phase II studies^[23] and has been shown in one phase III randomised trial to reduce the incidence of KC in high-risk immune-competent individuals with multiple previous skin cancers.^[24] Nicotinamide 500mg twice daily over 12 months reduced numbers of new KCs by 23% compared with placebo, with similar magnitudes of reduction observed for BCC and cSCC.^[24] The rate of AKs was also reduced by approximately 15%. The chemopreventive effect was lost during a 6-month post-intervention follow-up period, suggesting that nicotinamide’s mechanisms of action relate to the promotion rather than initiation stages of carcinogenesis.

Nicotinamide lacks the vasodilatory effects of nicotinic acid and was well tolerated. At very high doses (approximately 8g daily), nicotinamide has been associated with reversible liver function abnormalities. These side effects are not seen at lower doses. There is a potential drug interaction with carbamazepine.^[24][25]

Small phase II studies suggest that nicotinamide may be useful for the chemoprevention of KC in organ transplant recipients,^[26][27] but as yet there have been no large trials of its safety and efficacy in this population. Its effects on chemoprevention of melanoma are currently unknown.

Professor David Wilkinson

1. Yiasemides E, Sivapirabu G, Halliday GM, Park J, Damian DL. Oral nicotinamide protects against ultraviolet radiation-induced immunosuppression in humans. Carcinogenesis 2009 Jan;30(1):101-5 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19028705.
2. Jump up ↑Surjana D, Halliday GM, Martin AJ, Moloney FJ, Damian DL. Oral nicotinamide reduces actinic keratoses in phase II double-blinded randomized controlled trials. J Invest Dermatol 2012 May;132(5):1497-500 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/22297641.
3. ↑^{Jump up to: 024.124.2} Chen AC, Martin AJ, Choy B, Fernández-Peñas P, Dalziell RA, McKenzie CA, et al. A Phase 3 Randomized Trial of Nicotinamide for Skin-Cancer Chemoprevention. N Engl J Med 2015 Oct 22;373(17):1618-26 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26488693.
4. Jump up ↑Damian DL. Nicotinamide for skin cancer chemoprevention. Australas J Dermatol 2017 Aug;58(3):174-180 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/28321860.
5. Jump up ↑Chen AC, Martin AJ, Dalziell RA, McKenzie CA, Lowe PM, Eris JM, et al. A phase II randomized controlled trial of nicotinamide for skin cancer chemoprevention in renal transplant recipients. Br J Dermatol 2016 Nov;175(5):1073-1075 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/27061568.
6. Jump up ↑Drago F, Ciccarese G, Parodi A. Nicotinamide for Skin-Cancer Chemoprevention. N Engl J Med 2016 Feb 25;374(8):789-90 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26933858.

Read more from Professor David Wilkinson on recent research:

• New cryotherapy guidelines
• Accuracy of computer-aided melanoma diagnosis
• Dysplastic naevi genetic makeup