"Nicotinamide, a simple vitamin B3 derivative, is showing real promise as a practical tool for skin cancer prevention. In this large Veterans Affairs retrospective study of more than 33,000 patients, those prescribed oral nicotinamide (500 mg twice daily) had a 14% overall reduction in new skin cancers compared with those who did not take it.

The greatest impact was seen in squamous cell carcinoma, where risk dropped by more than 20%. Even more striking, patients who began nicotinamide after their very first skin cancer had risk reductions of nearly 50%. These findings highlight that timing matters; starting earlier may be the key to stronger protection. For clinicians, the appeal of nicotinamide lies in its accessibility, safety, and tolerability. Unlike systemic retinoids or invasive field therapies, nicotinamide is inexpensive, over-the-counter, and free from significant side effects.

While this study did not show broad benefit in solid organ transplant recipients, it still suggests potential advantages for selected patients in this vulnerable group when started early.

Overall, these results reinforce what many dermatologists have long suspected, nicotinamide is an underutilized, low-risk intervention that can make a difference in reducing skin cancer burden, especially for patients with an early history of disease."