Niacinamide Found to Reduce the Risk of New Skin Cancers

• Niacinamide supports the skin at the cellular level — It does this by restoring a vital molecule called nicotinamide adenine dinucleotide (NAD+), a coenzyme that every cell relies on for energy production, DNA repair, inflammation control, and mitochondrial health.

When prolonged UV exposure, oxidative stress, or aging depletes NAD+ levels, skin cells lose the energy needed to maintain normal repair processes. Niacinamide replenishes this supply, keeping your skin’s repair systems active and resilient.

• Inside your cells, niacinamide participates in the NAD+ salvage pathway — When NAD+ breaks down during normal metabolic activity, it forms niacinamide, which the body recycles by converting it into nicotinamide mononucleotide (NMN) and then back into NAD+. This cycle allows your cells to sustain energy production and DNA repair without interruption, ensuring that repair enzymes and antioxidant systems always have the resources they need.

• NAD+ fuels key DNA-repair enzymes — These include poly (ADP-ribose) polymerase (PARPs) and sirtuins, which identify and repair DNA strand breaks. When NAD+ levels drop, these enzymes cannot function effectively, leading to the accumulation of damaged DNA. By maintaining NAD+ availability, niacinamide keeps these enzymes working efficiently and supports the genetic stability of your skin cells.

• Niacinamide also reinforces your skin’s structural defenses — It stimulates ceramide production, strengthening the barrier that locks in moisture and shields against environmental damage.⁷ Because of its effects, dermatologists have used niacinamide for decades in both topical and oral forms to manage acne, rosacea, hyperpigmentation, and photoaging.⁸

• Niacinamide’s influence extends far beyond skin health — Clinical studies have shown benefits in conditions linked to metabolic stress, inflammation, and mitochondrial dysfunction, including neurodegeneration,⁹ glaucoma,¹⁰ chronic pain,¹¹ stress,¹² and even oxidative damage linked to excessive linoleic acid (LA) intake.

• How the study was designed — The research team analyzed data from 33,822 veterans between 1999 and 2024. They identified patients who had filled prescriptions for 500 milligrams (mg) of oral nicotinamide twice daily for more than 30 days and compared them with matched controls who had not received the supplement.

In total, 12,287 niacinamide users were matched with 21,479 nonusers based on factors including age, sex, prior skin cancer history, and use of other dermatologic treatments. The primary outcome was time to the next diagnosis of BCC or cutaneous SCC (cSCC).

• Niacinamide use lowered overall skin cancer risk — Across the full study population, niacinamide use was associated with a 14% lower overall risk of developing skin cancer. The benefit was most pronounced when supplementation began after the first skin cancer diagnosis, producing a 54% reduction in new cases.

However, this preventive effect diminished when treatment was started after multiple prior cancers. Both BCC and cSCC incidence decreased, with the strongest risk reduction seen in cSCC.

• Findings in immunocompromised patients — The study also evaluated a subgroup of 1,334 patients who were immunocompromised due to organ transplants. Among these transplant recipients, no overall significant reduction in cancer risk was observed. However, early use of niacinamide after the first cancer diagnosis was linked to fewer cases of cSCC, underscoring the importance of timing in its effectiveness.

• Early use of niacinamide may redefine preventive skin cancer care — According to the study’s lead author, Dr. Lee Wheless, assistant professor of Dermatology and Medicine at Vanderbilt University Medical Center and a staff physician at VA Tennessee Valley Healthcare System:

“There are no guidelines for when to start treatment with nicotinamide for skin cancer prevention in the general population. These results would really shift our practice from starting it once patients have developed numerous skin cancers to starting it earlier. We still need to do a better job of identifying who will actually benefit, as roughly only half of patients will develop multiple skin cancers.”¹⁴

• Study design and participants — The ONTRAC trial included 386 adults aged 30 to 91 years who had developed two or more nonmelanoma skin cancers in the past five years. Participants were randomly assigned to receive nicotinamide, 500 mg twice daily, or placebo for 12 months, with dermatologic evaluations every three months.

• What the results showed — After one year of supplementation, participants taking nicotinamide had 23% fewer new basal and squamous cell carcinomas than those taking placebo. The supplement also reduced actinic keratoses, precancerous lesions that signal future cancer risk, by 11% after three months and 15% after 12 months.

• Safety confirmed across all groups — Niacinamide was well tolerated, with no meaningful side effects. Unlike niacin, it did not cause flushing, headaches, or increased blood pressure, and no participants discontinued treatment due to adverse effects. Its clean safety profile made it an ideal option for older adults or those on multiple medications.

• Why the findings matter for high-risk patients — Lead investigator Diona Damian, MBBS, Ph.D., described niacinamide as “a new opportunity for skin cancer prevention,” noting that it is safe, inexpensive, and immediately accessible for those at greatest risk of recurrence.¹⁸

Supporting this view, Dr. Peter Paul Yu, the president of the American Society of Clinical Oncology at the time, called the results “a remarkably simple and inexpensive way to help people avoid repeat diagnoses of some of the most common skin cancers.”¹⁹

• Take small, evenly spaced doses throughout the day — For optimal health, I recommend taking 50 milligrams of niacinamide three times per day. You can also take it four times a day if you space out the dose evenly. Take a dose as soon as you get up, another before going to bed, and two more evenly spaced between those times.

• Higher doses can cause adverse effects — The problem with taking too much vitamin B3, whether in the form of niacin or niacinamide, is that it might backfire and contribute to cardiovascular disease and other side effects. Other potential side effects of high doses include nausea, vomiting, headache, dizziness, and fatigue.

• Make sure you're getting all the other B vitamins — Your body relies on the full spectrum of B vitamins to maintain optimal health, especially regular niacin, riboflavin (B2), folate (B9), and pyridoxine (B6).

Vitamin B3 is found in grass fed beef, liver, wild-caught Alaskan salmon, and bananas,²¹ while vitamin B6 is abundant in grass fed beef, potatoes, and bananas.²² As for folate, you can obtain it in spinach, broccoli, and asparagus.²³ Meanwhile, vitamin B12-rich foods include grass fed beef liver, wild rainbow trout, and wild sockeye salmon.²⁴

1. Optimize your vitamin D levels — Vitamin D activates receptors that regulate how your cells grow, repair, and communicate, helping reduce the risk of cancer by reducing DNA damage, improving immune surveillance, and promoting normal cell differentiation.²⁵

A study from the University of Eastern Finland found that individuals who took vitamin D regularly had nearly 50% lower melanoma risk, even among those with high-risk skin types.²⁶ Maintaining vitamin D levels in the 60 to 80 ng/mL (150 to 200 nmol/L) range provides the strongest protection.

While many studies discourage sun exposure, sunlight is your body’s primary and most efficient source of vitamin D. The key is to enjoy sunlight in a way that protects your skin from burning. Simple steps taken before and during sun exposure can make all the difference. For practical guidance on how to do this safely, read “Having Optimal Vitamin D Levels Helps Lower Your Risk of Melanoma.”

2. Nourish your skin from the inside out — Foods rich in antioxidants are especially valuable because they neutralize damaging free radicals. Prioritize carotenoid-rich fruits and vegetables such as carrots, sweet potatoes, tomatoes, and leafy greens. These pigments accumulate in your skin, where they act as a natural shield against oxidative damage.²⁷

Equally important are vitamins C and E, which work together to preserve skin integrity. Vitamin C fuels collagen synthesis, accelerates tissue repair, and maintains the connective structure that keeps your skin firm and resilient.²⁸ Good sources include bell peppers, citrus fruits, strawberries, and broccoli.²⁹

Vitamin E shields cell membranes from lipid peroxidation, a reaction that weakens your skin’s lipid barrier and speeds visible aging.³⁰ Pasture-raised eggs, grass fed beef liver, wild-caught fish, and leafy greens provide abundant amounts of this vitamin.

3. Improve sleep and circadian rhythm to boost skin repair — Your skin follows a daily rhythm of repair and renewal that peaks during sleep. Research shows that chronic circadian disruption not only weakens the skin barrier but also increases the risk of tumor formation by impairing clock genes that regulate cell division and DNA stability.³¹

Aim to get adequate, high-quality sleep nightly by creating a consistent bedtime routine, limiting blue light exposure in the evening, and getting natural sunlight in the morning to help reset your circadian rhythm. Keeping your room cool, dark, and quiet also supports deeper rest, allowing your skin the time it needs to repair and renew overnight.

4. Engage in regular physical activity — A study on melanoma shows that regular physical activity can slow tumor growth and enhance immune surveillance. Researchers also found that exercise boosts the activity of natural killer cells, improves blood flow to skin tissues, and reduces inflammatory signaling linked to tumor progression.³²

You don’t need strenuous workouts to gain the benefits. Regular, moderate movements such as walking, stretching, or light resistance exercise will do. Consistent activity also helps balance blood sugar and hormones, which play a direct role in maintaining healthy and resilient skin.³³

5. Be wise when it comes to sunscreen — Dermatologists often recommend daily sunscreen use to lower skin cancer risk, but many products on the market contain chemicals that can harm your health and the environment, including oxybenzone, octinoxate, homosalate, and octocrylene.³⁴

If you choose to use a sunscreen, look for zinc oxide or titanium dioxide instead and make sure they’re not nano-sized. Lotions or creams with zinc oxide offer the most stable and broad UVA and UVB protection, while titanium dioxide is a good alternative.

Avoid high-SPF products above 50, which often create a false sense of security and don’t provide significantly better protection. SPF measures UVB defense only, not UVA, which causes the most skin damage and aging. Ultimately, sunscreen should not be your first line of defense. The healthiest approach is safe, sensible sun exposure.