JAMA Dermatology

<jats:sec id="ab-doi250045-4"><jats:title>Importance</jats:title><jats:p>Nicotinamide supplementation has been studied as a chemopreventive medication for reducing skin cancer risk, but large-scale data are limited.</jats:p></jats:sec><jats:sec id="ab-doi250045-5"><jats:title>Objective</jats:title><jats:p>To determine the clinical efficacy of nicotinamide supplementation for skin cancer prevention in the general population and among solid organ transplant recipients.</jats:p></jats:sec><jats:sec id="ab-doi250045-6"><jats:title>Design, Setting, and Participants</jats:title><jats:p>A retrospective cohort study was conducted using electronic health record data (October 1, 1999, to December 31, 2024) from the Veterans Affairs Corporate Data Warehouse (CDW) of 33 822 patients. Analyses were conducted from January 17, 2025, to May 9, 2025. Patients who were exposed to nicotinamide were propensity score matched based on the number and year of skin cancers after which treatment with nicotinamide was initiated, age, sex, self-reported race, exposure to acitretin, exposure to field therapy, history of chronic lymphocytic leukemia, and history of solid organ transplant. The index date was the first prescription of nicotinamide filled within the VA system. Stratified Cox models were used to investigate the association of nicotinamide with skin cancer development.</jats:p></jats:sec><jats:sec id="ab-doi250045-7"><jats:title>Exposures</jats:title><jats:p>Nicotinamide, 500 mg, twice daily for longer than 30 days as documented in the electronic health record.</jats:p></jats:sec><jats:sec id="ab-doi250045-8"><jats:title>Main Outcomes and Measures</jats:title><jats:p>Time to the next skin cancer after baseline.</jats:p></jats:sec><jats:sec id="ab-doi250045-9"><jats:title>Results</jats:title><jats:p>There were 12 287 patients (mean [SD] age, 77.2 [8.9] years; 241 women [2.0%]; 31 [0.3%] American Indian or Alaska Native, 3 [&amp;amp;lt;0.1%] Asian, 13 [0.1%] Black or African American, 59 [0.5%] Native Hawaiian or other Pacific Islander, and 11 662 [94.9%] White individuals) exposed to oral nicotinamide, 500 mg, twice daily for longer than 30 days who were matched to 21 479 unexposed patients (mean [SD] age, 76.9 [8.7] years; 374 women [2.0%]; 49 [0.2%] American Indian or Alaska Native, 3 [&amp;amp;lt;0.1%] Asian, 16 [0.1%] Black or African American, 88 [0.4%] Native Hawaiian or other Pacific Islander, and 20 517 [95.3%] White individuals). Within the matched dataset, there were 10 994 instances of basal cell carcinoma after nicotinamide exposure and 12 551 cutaneous squamous cell carcinoma (cSCC). A total of 1334 (3.9%) in the matched cohort were solid organ transplant recipients. Overall, there was a significant 14% reduction in skin cancer risk. When nicotinamide was initiated after a first skin cancer, the risk reduction rose to 54%, although this benefit declined with initiation following subsequent skin cancers. This risk reduction was seen for skin cancers overall, basal cell carcinoma, and cSCC, with the greatest risk reduction seen for cSCC. Among solid organ transplant recipients, no overall significant risk reduction was observed, although early nicotinamide use was associated with reduced cSCC incidence.</jats:p></jats:sec><jats:sec id="ab-doi250045-10"><jats:title>Conclusions and Relevance</jats:title><jats:p>The results of this cohort study suggest that there is a decreased risk of skin cancer among patients treated with nicotinamide, with the greatest effect seen when initiated after the first skin cancer.</jats:p></jats:sec>

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A phase 3 randomized trial of nicotinamide for skin-cancer chemoprevention.

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Nicotinamide for skin-cancer chemoprevention in transplant recipients.

Nicotinamide for skin-cancer chemoprevention in transplantation.

Nicotinamide for secondary keratinocyte carcinoma prevention in solid organ transplant recipients.

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Frequency and timing of multiple skin cancer development in five cohorts.

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Risk of major adverse cardiovascular events following nicotinamide exposure.

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Validity of using billing codes from electronic health records to estimate skin cancer counts.

New primary nonmelanoma skin cancer in patients with a history of squamous cell carcinoma of the skin: implications and recommendations for follow-up.

Duration of acceptable delay between the time of diagnosis and treatment of melanoma, cutaneous squamous cell carcinoma and basal cell carcinoma.

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Development of phenotyping algorithms for the identification of organ transplant recipients: cohort study.

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Effect of nicotinamide in skin cancer and actinic keratoses chemoprophylaxis, and adverse effects related to nicotinamide: a systematic review and meta-analysis.

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A bioluminescent-based probe for in vivo non-invasive monitoring of nicotinamide riboside uptake reveals a link between metastasis and NAD+ metabolism.

Biosens Bioelectron

Sirolimus and secondary skin-cancer prevention in kidney transplantation.

Differences in skin cancer rates by transplanted organ type and patient age after organ transplant in White patients.

Risks of multiple skin cancers in organ transplant recipients: a cohort study in 2 administrative data sets.

Timing of subsequent new tumors in patients who present with basal cell carcinoma or cutaneous squamous cell carcinoma.

Consensus-based recommendations on the prevention of squamous cell carcinoma in solid organ transplant recipients: a Delphi consensus statement.

A phase II randomized controlled trial of nicotinamide for skin cancer chemoprevention in renal transplant recipients.

Br J Dermatol

Chemoprevention of basal and squamous cell carcinoma with a single course of fluorouracil, 5%, cream: a randomized clinical trial.

Tolerability of high-dose topical tretinoin: the Veterans Affairs Topical Tretinoin Chemoprevention Trial.

Skin cancer in the military: a systematic review of melanoma and nonmelanoma skin cancer incidence, prevention, and screening among active duty and veteran personnel.

Skin cancer risk factors and preventative behaviors among United States military veterans deployed to Iraq and Afghanistan.

J Invest Dermatol

Nicotinamide supplementation has been studied as a chemopreventive medication for reducing skin cancer risk, but large-scale data are limited.
To determine the clinical efficacy of nicotinamide supplementation for skin cancer prevention in the general population and among solid organ transplant recipients.
A retrospective cohort study was conducted using electronic health record data (October 1, 1999, to December 31, 2024) from the Veterans Affairs Corporate Data Warehouse (CDW) of 33 822 patients. Analyses were conducted from January 17, 2025, to May 9, 2025. Patients who were exposed to nicotinamide were propensity score matched based on the number and year of skin cancers after which treatment with nicotinamide was initiated, age, sex, self-reported race, exposure to acitretin, exposure to field therapy, history of chronic lymphocytic leukemia, and history of solid organ transplant. The index date was the first prescription of nicotinamide filled within the VA system. Stratified Cox models were used to investigate the association of nicotinamide with skin cancer development.
Nicotinamide, 500 mg, twice daily for longer than 30 days as documented in the electronic health record.
Time to the next skin cancer after baseline.
There were 12 287 patients (mean [SD] age, 77.2 [8.9] years; 241 women [2.0%]; 31 [0.3%] American Indian or Alaska Native, 3 [<0.1%] Asian, 13 [0.1%] Black or African American, 59 [0.5%] Native Hawaiian or other Pacific Islander, and 11 662 [94.9%] White individuals) exposed to oral nicotinamide, 500 mg, twice daily for longer than 30 days who were matched to 21 479 unexposed patients (mean [SD] age, 76.9 [8.7] years; 374 women [2.0%]; 49 [0.2%] American Indian or Alaska Native, 3 [<0.1%] Asian, 16 [0.1%] Black or African American, 88 [0.4%] Native Hawaiian or other Pacific Islander, and 20 517 [95.3%] White individuals). Within the matched dataset, there were 10 994 instances of basal cell carcinoma after nicotinamide exposure and 12 551 cutaneous squamous cell carcinoma (cSCC). A total of 1334 (3.9%) in the matched cohort were solid organ transplant recipients. Overall, there was a significant 14% reduction in skin cancer risk. When nicotinamide was initiated after a first skin cancer, the risk reduction rose to 54%, although this benefit declined with initiation following subsequent skin cancers. This risk reduction was seen for skin cancers overall, basal cell carcinoma, and cSCC, with the greatest risk reduction seen for cSCC. Among solid organ transplant recipients, no overall significant risk reduction was observed, although early nicotinamide use was associated with reduced cSCC incidence.
The results of this cohort study suggest that there is a decreased risk of skin cancer among patients treated with nicotinamide, with the greatest effect seen when initiated after the first skin cancer.

Nicotinamide for Skin Cancer Chemoprevention.

Nicotinamide for Skin Cancer Chemoprevention

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