An inexpensive vitamin B₃ product that is widely available over the counter has been shown to significantly reduce the risk of developing further skin cancers in patients who have already been diagnosed with nonmelanoma skin cancer. This product is nicotinamide, also known as niacinamide.
"This is the first clear evidence that we can reduce skin cancers using a simple vitamin, together with sensible skin protection," commented senior study author Diona Damian, MBBS, PhD, professor of dermatology at the Dermatology University of Sydney in Australia.¹ "It is safe and...inexpensive, and this one is ready to go into the clinic," she said. “Nonmelanoma skin cancers such as basal cell and squamous cell carcinoma are the most common cancer types worldwide.”
The results show that patients who took 500 mg of nicotinamide twice daily, for 1 year, demonstrated a 23% reduction in new diagnoses of nonmelanoma skin cancers, compared with those who took a placebo. Specifically, new diagnoses of basal cell carcinoma were reduced by 20%, squamous cell carcinoma by 30%, and actinic keratoses (pre-cancerous lesions) by 13%.
Nicotinamide "presents a new chemopreventive opportunity against nonmelanoma skin cancer” that is readily incorporated into dermatology practice, the researchers conclude.
They speculate that nicotinamide offers protection against the development of subsequent skin cancer by working in two ways: enhancing the repair of DNA in sun-damaged skin cells, and preventing immune suppression in the skin by ultraviolet light. This research shows the benefits of nicotinamide in patients who have already had nonmelanoma skin cancer. However, the data is insufficient for patients with no such history, and additional long term studies are needed.
One precaution to keep in mind: although nicotinamide shows protective effects against UV exposure, it does not prevent sunburn! Even when taking nicotinamide supplements, proper and adequate sun protection remains the first step in skin cancer prevention. If you do have a history of nonmelanoma skin cancer, ask your health care provider about nicotinamide today!
What is it and how does it work?
Efudex, also known as fluorouracil (generic) or 5FU, is a chemotherapeutic cream that has been around for decades and is still considered the gold standard in treating actinic keratoses, widely known as “pre-cancers,” or AKs. It is typically covered by most insurance carriers. Current out-of-pocket costs range from $50-105, with coupons often available (see www.goodrx.com).
Efudex has a chemical mechanism that is specific for all AKs and treats both the clinically obvious as well as the subclinical AKs. It works by causing the death of the fastest growing cells, and can be used on virtually any sun-exposed area of the body. Moreover, it is also effective at treating small, thin nonmelanoma skin cancers. Statistics show that around 40% of people who use 5FU become completely clear of AKs. For all other patients, it resolves a large majority (around 80-90%) of their AKs.
What are the downsides of Efudex?
It causes a slow process of inflammation, usually taking 2-3 weeks of active treatment and another 2 weeks to completely recover. During this time most people will have discomfort and will not be able to hide the inflammatory reaction from others.
What are the cosmetic side effects of Efudex?
Aside from excellent field treatment of pre-cancers (thereby reducing the risk of skin cancers), there are long-known cosmetic benefits that aren't emphasized enough! A 2009 study¹ documented that Efudex treatment improves skin appearance by lessening coarse wrinkles, fine wrinkles, rough texture, mottled hyperpigmentation, dark spots, and dull skin tone…some very welcome and popular side effects of completing this treatment! My clinical experience has been that after Efudex, most patients are extremely satisfied with the improvement they see both medically and aesthetically, and would do it again if needed.