Vitamin B3 and Skin Cancer – a bit more prevention.

A recent study has suggested that vitamin B3 otherwise known as nicotinamide may be able to reduce pre-cancerous skin lesions like actinic keratosis and non-melanoma skin cancers, such as basal and squamous cell cancers.

The Australian Oral Nicotinamide to Reduce Actinic Cancer (ONTRAC) study was run over 12 months and published in the NEJM in 2015. The study gave people who had a high risk of skin cancer 500mg of nicotinamide twice a day. The authors found that nicotinamide reduced non-melanoma skin cancer by a quarter with comparable efficacy against both basal cell and squamous cell cancers. If you want to learn about how nicotinamide may do this have a read of these review articles. Role of Nicotinamide in DNA Damage, Mutagenesis, and DNA Repair and Nicotinamide for skin cancer chemoprevention.

 

Aktinic keratosis or solar keratosis

Squamous cell cancer

Basal cell cancer

Lentigo maligna or malignant melanoma

As with all medical advances, there are some caveats.

The trial subjects were considered at high risk defined as those having had 2 or more non-melanoma skin removed in the last 5 years. In reality that would probably be most of my over 50 year patient here in North Queensland.

The benefit of nicotinamide disappeared once the medication was stopped after 12 months.

Nicotinamide was found to be safe for the duration of this study, although some people did complain of nausea. A smaller dose of 500mg once a day may help those and has been shown to have some benefit albeit less.

The nicotinamide used in this study was donated by Blackmores. Just remember that you need NICOTINAMIDE, not nicotinic acid or niacin, as at that dose you’ll end with facial flushing, headache and hypotension with the latter.

Importantly, taking nicotinamide doesn’t replace the need for protecting yourself from the sun by avoiding being out in the heat of the day, wearing long sleeves and pants, wearing a hat and using sunscreen. The study noted that even for these high risk people who have had skin cancer removed, only 50% used sunscreen. Here’s my hint, to help you remember to use sunscreen.

The study didn’t look at incidence of melanomas, apparently that is next on the authors agenda.

If you recognise any of the spots shown above on your face in the mirror go and see your GP.

May I indulge a short but very sad anecdote from a few year ago. Everyone including the butcher and baker told this bloke to get that ugly spot on his cheek looked at. Instead he put on a band aid and ignored everyone including his wife. Finally, when the spot turned into an even uglier, smelly, ulcer he saw a doctor. Alas it was far too late to save him the squamous cell cancer despite surgery and radiotherapy.


References

http://www.nejm.org/doi/full/10.1056/NEJMoa1506197#t=article

https://www.cancercouncil.com.au/blog/the-role-of-vitamin-b3-in-reducing-non-melanoma-skin-cancer/

https://www.skincancer.org/publications/the-melanoma-letter/spring-2016-vol-34-no-1/nicotinamide

https://www.hindawi.com/journals/jna/2010/157591/

http://onlinelibrary.wiley.com/doi/10.1111/ajd.12631/full

Pictures are from a great skin website from New Zealand called Dermnet