Nicotinamide Linked to Reduced Melanoma Risk in VA Cohort

Key Takeaways

• Nicotinamide exposure was associated with a 25% reduction in melanoma incidence in a large VA cohort study presented at AAD 2026.
• Risk reduction was more pronounced in patients without prior melanoma and when initiated after 1–3 prior non-melanoma skin cancers.
• The association was significant for invasive melanoma but not melanoma in situ.

Nicotinamide exposure was associated with a 25% reduction in melanoma incidence in a large VA cohort, according to data from a retrospective cohort study presented at the 2026 American Academy of Dermatology Annual Meeting.

Investigators analyzed 30,741 patients from the Veterans Affairs corporate data warehouse with a history of skin cancer, using propensity-score matching to balance key variables including age, sex, race, prior skin cancer burden, immunosuppression, and exposure to chemopreventive or field therapies.

Among 11,064 patients exposed to nicotinamide 500 mg twice daily for more than 30 days and 19,677 matched controls, the cohort was predominantly older (mean age ~77 years), White, and male. Over the study period, nicotinamide exposure was associated with a 25% reduction in melanoma incidence. Stratified analyses demonstrated that the association was strongest when nicotinamide was initiated after 1 to 3 prior nonmelanoma skin cancers. In patients without a history of melanoma, incidence was reduced by 27%, whereas those with prior melanoma had a nonsignificant 11% reduction. Notably, nicotinamide exposure was associated with reduced risk of invasive melanoma but not melanoma in situ.

Limitations include the retrospective design, reliance on electronic health record data, and limited generalizability given the predominantly male veteran population. Residual confounding cannot be excluded despite propensity matching.

“This cohort study of over 30,000 patients observed that nicotinamide exposure was associated with a significant reduction in melanoma incidence, particularly for invasive disease and when initiated prior to melanoma diagnosis,” the authors wrote.

Source: Knox K, Breglio K, Hartman R, and Wheless L. Nicotinamide Exposure for Melanoma Prevention. Poster 73232. Presented at: American Academy of Dermatology Annual Meeting; March 27-31, 2026; Denver.