To B3, or not to B3? That was the question asked in this controlled trial in which the authors were able to show that oral nicotinamide (vitamin B3) is able to reduce further skin cancer development in high risk patients. The study was limited to non-melanoma skin cancer. Previous results had suggested that B3 can protect against UV damage and likely does so by enhancing immune system function which can otherwise be downregulated by UV light-induced damage. So the authors recruited 386 patients with at least two previous non-melanoma skin cancers in the preceding five years. Using a double-blind trial design, they were assigned randomly to either have 500mg Vitamin B3 twice a day, or placebo for 12 months and were then followed for a total of 18 months, being reviewed clinically every three months during that period by dermatologists. The primary aim was to see if there was a difference in the number of new basal and squamous cell carcinomas forming during that period between the B3-treated group versus placebo-controls. The authors found that the Vitamin was well tolerated and there were no side-effects attributable to its ingestion. After a year, the data showed that the rate of non-melanoma skin cancer formation in the treated arm was 23% lower overall: 20% less basal cell and 30% less squamous cell carcinomas. Furthermore the rate of actinic keratoses was also lower at 20%. Interestingly, upon cessation of treatment, the remaining six months of the study showed no continued benefit of the treatment, indicating that it must be ingested continuously to sustain the anti-tumour effect. This study, conducted in Australia, should have a significant effect on public health at a time when skin cancers are on the rise. The area is complex however, as use of non-steroidal anti-inflammatory drugs has previously also been linked to a reduction in non-melanoma skin cancer; the role of the immune system and inflammation in these disorders is more complex than might first appear. 

A phase 3 randomized trial of nicotinamide for skin-cancer chemoprevention.
Chen AC, Martin AJ, Choy B, et al.
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Jonathan CP Roos

Harvard, Cambridge & Moorfields-trained Consultant Oculoplastic Surgeon and academic based in London at Publishes in the world’s leading medical journals and lectures internationally on aesthetics, eyelid diseases and thyroid eyes.

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