By Ana Espino | Published on July 01, 2026 | 4 min read
Nicotinamide, a form of vitamin B3, has attracted
growing interest in recent years as a potential strategy for preventing non-melanoma
skin cancers. Inexpensive, well tolerated, and readily available, it is
already recommended by some dermatologists for patients at high risk of
developing new skin cancers. However, despite encouraging findings from several
studies, its true clinical effectiveness remains a matter of debate.
In a critical review published in the American Journal of
Clinical Dermatology, Eugene Tan and Hywel Williams reassess
the latest scientific evidence on nicotinamide. The authors examine, in
particular, a large retrospective study involving more than 33,000 U.S.
veterans, along with the major meta-analyses published in recent years, to
determine whether current evidence is sufficient to support its routine use in
clinical practice.
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Encouraging Findings, but Evidence Remains Limited
The most recent retrospective study reported a 14%
reduction in the overall risk of skin cancer among patients receiving
nicotinamide, with a 22% reduction in the risk of cutaneous squamous cell
carcinoma. The benefits appeared to be greater when treatment was initiated
early, following a patient's first episode of skin cancer.
However, the authors caution that these findings should be
interpreted carefully. The study has several important methodological
limitations that may have overestimated the observed protective effect. These
include the absence of information on major risk factors such as skin
phototype, cumulative ultraviolet exposure, and photoprotection habits, as
well as the potential for selection bias, difficulties in verifying
long-term treatment adherence, and a study population composed almost
exclusively of older men, limiting the generalizability of the results.
Researchers also place these new findings within the broader
context of previous clinical trials and meta-analyses. While the ONTRAC
trial, published in 2015, demonstrated a protective effect of nicotinamide
in high-risk patients, other studies—particularly those involving solid
organ transplant recipients—failed to show a significant benefit. Likewise,
the two most recent systematic reviews concluded that the available evidence
remains low in quality and does not allow a definitive conclusion that
nicotinamide reduces the incidence of skin cancer.
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Should Nicotinamide Be Recommended in Clinical Practice?
This review highlights that nicotinamide has a biologically
plausible mechanism of action, notably by promoting the repair of UV-induced
DNA damage and improving the energy metabolism of skin cells.
Nevertheless, the authors argue that biological plausibility alone is not sufficient
to justify routine clinical recommendations in the absence of robust clinical
evidence.
They emphasize that current data rely largely on
observational studies or on a limited number of randomized controlled trials,
many of which were conducted in highly specific patient populations. Before
nicotinamide can be incorporated into international skin cancer prevention
guidelines, they call for large, multicenter, randomized, placebo-controlled
clinical trials to reliably evaluate its efficacy and benefit-risk profile.
In the meantime, the authors stress that proven preventive
measures remain unchanged: limiting sun exposure, using broad-spectrum
sunscreen regularly, wearing protective clothing, and ensuring regular
dermatological surveillance for high-risk individuals. Nicotinamide remains
a promising preventive strategy, but according to the authors, the
scientific verdict has not yet been definitively reached.
About the author – Ana Espino
PhD in Immunology, specialized in Virology
As a scientific writer, Ana is passionate about bridging the gap between research and real-world impact. With expertise in immunology, virology, oncology, and clinical studies, she makes complex science clear and accessible. Her mission: to accelerate knowledge sharing and empower evidence-based decisions.
