Originally printed in Lake Norman Publications October 2023
Skin cancer, the most common type of cancer in the US, is largely caused by sun exposure. While most of us had our share of sun growing up, many patients ask about steps to take now to reduce the risk of developing skin cancer in the future. In particular, I often hear the question in clinic: What else can we do? We know the standard guidelines -- we know to wear sunscreen and sun-protective clothing, avoid tanning beds, and schedule regular skin checks. But what else can we do?
In addition to the basics, here are five bonus ways that have shown promise for reducing our skin cancer risk. As always, discuss any treatment options with your dermatologist first to see if it is right for you and your skin.
1. To Vitamin B3 or Not to B3 (Answer: Definitely B3)
The most convincing studies on skin cancer prevention have been on Nicotinamide (Vitamin B3), a supplement available over the counter that has protective effects against sun damage. In large, well-controlled studies in Australian patients with a history of skin cancer, Nicotinamide 500 mg taken twice daily reduced the rate of new squamous cell carcinomas (SCCs) by 30%, basal cell carcinomas (BCCs) by 20%, and precancerous lesions actinic keratoses (AKs) by 13% at one year. Researchers propose that nicotinamide works by helping the repair of DNA damage caused by UV radiation and by boosting the immune system's ability to fight cancer cells. Nicotinamide is well-tolerated and safe at recommended doses.
Bottom line: The evidence is strong for taking Vitamin B3 500 mg twice daily, especially for anyone with a history of skin cancer or precancers.
2. For those at high risk for SCC: Acitretin
Acitretin is a retinoid that has been found in studies to reduce new SCCs by 60% and AKs by 50% in high-risk patients, especially those who have received an organ transplant or are immunosuppressed. As a general guideline, acitretin may be considered in patients with five or more skin cancers in two to three years. In practice, we typically start acitretin at 10 mg daily. This medication’s side effects include elevated cholesterol, headaches, muscle or joint aches, dryness, and abnormalities on liver tests. Acitretin also has a relatively high cost.
Bottom line: Patients with an extensive history of SCC (five or more in the past 2-3 years) may consider starting acitretin 10 mg daily, keeping in mind the side effects and high cost.
3. Staying Laser-Focused: Fractional Lasers
Fractional lasers have long been used to resurface the skin and treat various conditions such as scarring, pigmentation, and photoaging. This type of laser delivers precise microbeams of light to stimulate the regrowth of healthy new tissue. In some studies, fractionated lasers reduced precancerous AKs by 60-75% for up to 3 years. Overall direct studies on preventing skin cancers using fractionated lasers are still limited. In one recent study, fractionated laser was found to decrease the risk of subsequent skin cancer development from 40% to 21% in patients with a history of skin cancer. Scientists suggest fractional lasers may reduce the risk of skin cancer by simulating fibroblasts to regenerate photodamaged skin and promoting DNA repair.
Bottom line: Studies are relatively new, but fractional lasers show early promise for reducing precancers and subsequent skin cancers.
4. Going Vegan: Polypodium leucotomos
Polypodium leucotomos (brand name: Heliocare) is a plant extract that protects against the damaging effects of ultraviolet radiation. Available over the counter, polypodium leucotomos 240 mg twice daily is routinely recommended for patients with sun sensitivity. Whether polypodium leucotomos can help prevent skin cancer is still being studied. One preliminary study using polypodium leucotomos for six months significantly decreased AK recurrence. Left untreated, 0.025% to 16% AKs have been reported to transform into SCCs. This extract works through antioxidative and anti-inflammatory properties. While polypodium leucotomos cannot replace sunscreen, it may provide an additional SPF 3-8 of sun protection.
Bottom line: Consider polypodium leucotomos 240 mg twice daily to increase the skin’s resistance to the sun.
5. Throwing Shade: Car Window Tints and Films
Interestingly, skin cancers occur more commonly on the left side in America and on the right side in Australia, correlating to the driver’s side in these countries. Car window glass blocks UVB rays (5% of sunlight), but not UVA rays (95%). As both UVB and UVA rays can lead to DNA damage resulting in skin cancer, adding window tints or films to increase UVA protection can reduce the risk of skin cancer down the road. A recent study found that when sunlight was filtered through a UV-absorbing tinted glass window, skin cell death was reduced by 93%. According to the Skin Cancer Foundation, applying a window tint or film is an effective way to prevent skin cancer over time.
Bottom line: Car window tints and films help reduce UVA rays that cause skin cancer.
In addition to fundamental sun protection recommendations, there are promising studies looking into the preventative properties of:
1. Nicotinamide (Vitamin B3)
2. Acitretin
3. Polypodium leucotomos
4. Fractionated lasers
5. Car windows tint/film
Stay tuned as more research on reducing the risk of skin cancer come out. If an ounce of prevention is worth a pound of cure, that could save a lot of skin!
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