QWhat is a cheap over-the-counter supplement that may help reduce skin cancer in high-risk patients?

Medically reviewed on 9.1.2022 by Mark Lebwohl, MD

You know those patients with multiple skin cancers that you see a couple times a year or more, and besides telling them to continue with sun protection you wish you could offer them something else?  

Let’s talk about nicotinamide, otherwise known as niacinamide, or vitamin B3. That’s right—so even your patients who hate taking anything that is not “natural” might actually take it once you tell them it’s just a vitamin! Not only does it have an excellent safety profile, but it has a decent study to back up it’s use in patients at high risk for developing non-melanoma skin cancer.  

This study published in the New England Journal of Medicine in 2015 showed that taking nicotinamide 500mg twice daily for a year cut the rate of new BCCs and SCCs by 23% compared to placebo in patients deemed to be high risk for skin cancer. The study included 386 patients who had two or more non-melanoma skin cancers within the past 5 years. Although please be mindful that this study did not evaluate for the reduction of melanoma or other rarer types of skin cancer.  

Vitamin B3 is cheap and easily found at pharmacies and vitamin shops. It currently costs about $28 for a 2-month supply of 120 pills. Make sure to tell your patients to pay close attention to the bottle though, because if they pick up niacin (a different form of vitamin B3) instead, they may develop flushing and a headache.  

Of note, the branded supplement Heliocare Advanced contains nicotinamide. Many dermatology offices choose to carry this product as it also contains polypodium leucotomos extract, an antioxidant which studies have shown helps boost the body’s natural defense against UV radiation. 

Who do I recommend OTC niacinamide to? Besides my patients with 2 or more non-melanoma skin cancers, I also recommend it to those with other conditions predisposing them to NMSC such as those with chronic lymphocytic leukemia, HIV, or patients with a history of organ or stem cell transplantation who are on immunosuppressive medication.

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References:

1. Chen A, Chinniah N. A Phase 3 Randomized Trial of Nicotinamide for Skin-Cancer Chemoprevention. N Engl J Med 2015; 373:1618-1626. DOI: 10.1056/NEJMoa1506197 
2. Nestor M, Swenson N. Safety and Efficacy of Oral Polypodium leucotomos Extract in Healthy Adult Subjects. J Clin Aesthet Dermatol. 2015 Feb; 8(2): 19–23.