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Skin Cancer Prevention: Beyond Sunscreen

Premier Dermatology and Mohs Surgery of Atlanta
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When enjoying time outdoors, there is still no substitute for sunscreen, clothing, umbrellas and shade for preventing future skin cancers. However, a number of medicines and one vaccine have attracted attention because of the possibility that they decrease the number of skin cancers that someone can expect to develop. From vitamin B3 to a fern extract called P. leucotomos, the future is looking brighter.

Nicotinamide, also known as niacinamide, has strong evidence for being able to decrease the number of actinic keratoses (precancers) and squamous cell carcinomas in high risk patients. In a 2015 study published in the New England Journal of Medicine, 386 patients who had at least two skin cancers in the previous five years took either nicotinamide 500mg two times per day or placebo for 12 months. The group taking nicotinamide developed 23% fewer non-melanoma skin cancers than the placebo group.

More recently, a 2017 study in the International Journal of Cancer analyzed data about nicotinamide intake and skin cancer from the Nurses Health Study and the Health Professionals Follow-Up Study, two large databases following cohorts of individuals in an attempt to gather useful health information. This study agreed that nicotinamide intake was associated with a lower risk of squamous cell carcinoma, but the study did raise the question of whether we fully know the effects of nicotinamide on basal cell carcinoma or melanoma.

Larger, longer-term studies would be helpful, but the current evidence is robust enough to suggest that someone with a strong history of precancers called actinic keratoses or of squamous cell carcinomas might consider taking nicotinamide 500mg two times per day. Importantly, nicotinamide must not be confused with niacin, a close cousin that causes flushing and other side-effects. Nicotinamide is also known as niacinamide. Niacin is also known as nicotinic acid. Word soup!

Is there help for basal cell carcinoma? A “metaanalysis,” which is a study that pools and analyzes all the results of lots of smaller studies was published in 2016 looking at aspirin and other NSAIDS (for example, ibuprofen) and found that use of one of these medicines was associated with about a 10% lower risk of basal cell carcinoma.

Even more intriguing, vaccination against the human papilloma virus (HPV) may decrease the number of cancers that one develops. The Gardasil vaccine is indicated for prevention of genital warts and cervical cancer and is typically administered to young females, but the HPV virus comes in many variations and types, and theoretically it would not be surprising if vaccination against a few of these viruses protected against the effects of other HPV strains. Use of this vaccine in an adult to prevent skin cancer would be off-label and experimental. However, two patients reported on in a recent publication in the Journal of the American Medical Association (JAMA) were developing an average of 10 skin cancers per year that dropped to an average of 3 to 4 skin cancers per year after vaccination.

There is not time to discuss every possibility, but a fern called Polypodium leucotomos appears to decrease the risk of UV damage and sunburn when taken by mouth in the form of the supplement Heliocare. Some dermatologists advocate its use in addition to sun screen when someone will find themselves suddenly thrust into a very sunny or tropical environment such as during a sunny vacation.

As always, talk with your dermatologist before starting any new medicine or supplement. And, when thinking about new and exciting studies, one important caveat to keep in mind is the possibility of “publication bias.” This is the general rule that exciting studies with intriguing results tend to get published and negative studies without exciting findings tend to get rejected. Publication bias matters because its effect is to allow publication of studies whose results are not real but rather happened by chance. Careful consideration to evidence quality must always be given before embarking on a new therapy.  ■

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This month's issue

Farrah Haidar, left, and Hala Yassine, are two of the seven sisters involved in Seven Sisters Scones in Johns Creek, offering their customers a modern take on a traditional breakfast treat.
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