4 ways to protect against skin cancer (other than sunscreen)

It’s almost May and here in the Northeast, front-of-the-pharmacy aisles are filled with myriad brands and types of sunscreen. While sunscreen is essential to lowering your risk for skin cancer, there are other simple, over-the-counter options you can incorporate into your summer skin protection routine.

Nicotinamide may help prevent certain skin cancers

Nicotinamide is a form of vitamin B3 that has been shown to reduce the number of skin cancers. In a randomized controlled trial performed in Australia (published in the New England Journal of Medicine), the risks of basal cell carcinoma and squamous cell carcinoma were significantly reduced — by 23%. Nicotinamide has protective effects against ultraviolet damage caused by sun exposure. The vitamin is safe and can be purchased over the counter. We recommended starting the vitamin (500 mg twice a day) to all our patients with a history of a basal cell carcinoma or squamous cell carcinoma, or with extensive skin damage due to sun exposure. One caveat is that the vitamin must be taken continuously, as the benefits are lost once stopped.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDs, such as ibuprofen and aspirin, may have a modest effect on skin cancer prevention. A systematic review showed that the risk of squamous cell carcinoma was reduced by 15% with non-aspirin NSAIDs, and by 18% with any NSAID. Some studies of melanoma have also shown positive results; one found a 43% reduction in melanoma with continuous aspirin for five years, while other studies have failed to show any risk reduction. NSAIDs are known to inhibit an enzyme responsible for inflammation and pain, known as COX-2, which is overexpressed in squamous cell carcinomas. A limitation to many of the studies on NSAIDs in skin cancer is that the amount of NSAID taken varied. Especially at higher doses, NSAIDs are associated with other side effects, such as ulcers, and so I do not routinely recommend that my patients take these drugs to lower skin cancer risk.

Polypodium leukotomos

Polypodium leukotomos is a tropical fern found in Central and South America that has antioxidative, immunomodulatory, and anti-inflammatory effects, and is being marketed as an oral “sunscreen.” A recent small study of 22 patients showed that the fern extract altered the effects of UVB light (the more carcinogenic form of ultraviolet light) in 17 of the 22 patients to varying degrees. However, it is important to recognize that there are limitations to this study. First, it was unable to evaluate UVA light, which also causes skin cancer. Second, it is difficult to determine the most appropriate dose from the study. The participants received two doses of 240 mg of polypodium leukotomos two hours and one hour before ultraviolet exposure, but it is not clear how best to advise patients to use it. So, you may wonder whether I recommend this to my patients. The answer is, not yet. But I do plan to try the extract myself and on my husband (who has a history of skin cancer) this summer. Just keep in mind, this does not replace sunscreen and sun-protective clothing.

Watch your alcohol intake

Although alcohol is not a classic “over-the-counter” product, it has been in the spotlight in the past year, as alcohol is estimated to be responsible for 3.5% of all cancer deaths. Two meta-analyses suggested an association between skin cancer and alcohol intake. One study found that the risk of basal cell carcinoma increased by 7% and squamous cell carcinoma by 11% for every standard beer or small glass of wine each day. Another study showed a 20% increase in melanoma in drinkers, and the risk increased with the number of drinks. However, these studies didn’t take into account other factors that could affect the results, some of which cannot be measured. One example is that ultraviolet light is the main factor that increases basal cell carcinoma and squamous cell carcinoma, and alcohol consumption has been associated with behaviors that increase one’s risk of getting a sunburn. So what is the recommendation? The American Cancer Society recommends limiting alcohol consumption to one drink per day for women and two drinks per day for men.

And you still need sunscreen!

Since we have yet to find a magic pill that completely prevents sunburns and eliminates skin cancer risk, this is my plug for good old-fashioned sunscreen. Sunscreen has been shown to reduce both melanoma and squamous cell carcinoma. Randomized prospective studies in Australia showed that individuals who used daily sunscreen had a 50% reduction in melanoma and a 40% reduction in squamous cell carcinoma, compared to individuals who used sunscreen intermittently. So when the sun and warm weather beckon, remember to apply a broad-spectrum sunscreen with at least SPF 30 prior to going out in the sun, reapply every two hours, and apply liberally: 1 teaspoon to each arm, head and neck, front torso, and back; and 2 teaspoons to each leg.

Related Information: Skin Care and Repair


  1. Clinica Vicario

    It´s important to keep insisting: the sun must be taken with caution. But not only that. A good hydration is the fundamental step to prepare the skin for the summer. “It is also necessary to be prudent during the first sunny days. We also have to use protective factors with highs, over 30, repeatedly during exposure, especially if we bathe in the sea. ” Give importance and take into account the hours in which we put in the sun, “the best is early morning and late afternoon, avoiding as much as possible the time when the sun strikes more perpendicular on the Earth, during the midday “,

  2. Jijibhoy Patel MD

    In my practice of 37 yrs in Int Med ., I had notice to have tremendous flushing to see Pts discontinued the meds. Very few contd. if given in small incremental doses . Or take less than 500 mg doses . Also be aware of side effects like PUD.
    Some tolerated if ASA was added.for reducing skin flushing.
    Dr Jijibhoy J. Patel, MD.

  3. Smiley Snaps

    It is not necessary to be exposed to the Sun which lizards. To generate vitamin D, it suffices with the Sun that comes to us indirectly, through reflection.

    The obsession to have darker and darker skin is a fashion.

  4. Dr Santiago Vidal-Asensi

    Dear Casandra: vitamin D is produced in the skin by the effect of UVB rays on the precursor. As the same wave lengths that produce Vit D in the skin are that induce Skin Cancer via mutagenesis, it is question of time to get a skin cancer. If a patient is Vit D defficient/insufficient, I recommend him Vit D supplements.

  5. Nancy Lorance

    Recently an article published in the Cell Journal questioned whether or not niacinamide’s anti-aging vascular properties (angiogenesis – in mice) could increase cancer risk in humans. They cautioned that more research needs to be done to answer this question. Do you still recommend niacinamide be used before this research is completed?

  6. Santiago Vidal-Asensi

    Dear Emily: Polypodium leucotomos extract is a well known oral photo protector since 30 years ago. I use it in preventing sunburn, melasma, polymorphic sun eruption, and chronic actinic damage, among others.
    Thomas B Fitzpatrick, the most famous chairman in dermatology of Harvard University was very fond of this compound, and used it as an adjuvant in PUVA therapy, like also did Pathak, and it showed useful in psoriasis and vitiligo treatment.
    There are hundreds of papers about it, that you can find easily in Pubmed, some of them written by Fitzpatrick, Pathak, and Spanish collaborators like Salvador Gonzalez.
    My oldest daughter takes it in summer since 10 years ago, to prevent sun damage.
    Yours sincerely
    Santiago Vidal-Asensi. MD. MC
    Dermatology Department, Central Military Hospital. Madrid, Spain
    Former coordinator of GEF (Spanish Group of Photobiology, of the Spanish Academy of Dermatology)

  7. Jafar Bassim Abbas

    Nice suggestions. Omega-3 fatty acid rich foods are highly recommended and if using a sunscreen, I would suggest natural sunscreens particularly the coral reef-inspired sunscreens developed in Australia as these coral reefs survived for many years under the harsh sun.

  8. Ajay Chander R.

    By which mechanism aspirin cures such stuff and what about foods that constitute vitamin B’s .

  9. Sue

    How do you prevent getting prickly heat ?
    Every time l am exposed to the heat l really suffer.. l use strong sun creams and antihystame and now under a skin

  10. Mark L

    1. Minimize exposure.
    2. Cover exposed skin with UV rated clothing.
    3. Stay hydrated.
    4. Assess the risk, if you’ve had skin cancer once, you’re more than likely to get it again.

  11. Mohammed Abdulaziz

    thanks for these valuable information.

    do you recommend vitamin B3 twice daily for healthy people even though these vitamins might have adverse effect especially on hormones.

    I was shocked by NSAID ability in reducing cancer and I wanna ask is this based on the paper you were referring to or based on experience. Also it’ll be great if you could share the paper link so we could have a look and get to know this relation.

    once again thanks a lot for sharing these information

  12. Carin Trainer

    Astaxanthin has been listed as a preventative measure.

  13. Cassandra

    And what about the protective action of having proper Vit D levels in the body? and the fact that the skin can only make Vit D when exposed to sunlight between 10-2 pm? And that skin cancer wasn’t such the huge thing it is now until sunscreens came into the picture?

  14. Mary

    Do the foods that supply good levels of Vitamin B3/Niacin, block the synthesis of Vitamin D?

  15. Nancy OConnor

    No mention of increasing Fruit/ Vegetable intake
    to help prevent Skin CA?

  16. C Sumeghy

    Try waring clothes with spf 50 or 80. Same with wide brimed hats spf 50.

  17. carolyn velez

    where is the reply to the above question about B3 foods/

  18. Lanie

    I would suggest adding a 5th way: wearing wide-brimmed hats and sunglasses while outside, to reduce the amount of sunlight that reaches the face, neck, and eyes.

  19. Mugisha bienfait

    By which pharmacological mechanism aspirin prevent skin cancer!?

  20. Sandy

    Top 10 Niacin Rich Foods
    1) Turkey. 1 breast: 101 mg (over 100% DV)
    2) Chicken breast. 3 oz: 8.9 mg (44% DV)
    3) Peanuts. 1 cup: 21.9 mg (over 100% DV)
    4) Mushrooms. 1 cup: 7.6 mg (34% DV)
    5) Liver. 1 slice: 11.9 mg (60% DV)
    6) Tuna. 3 oz: 11.3 mg (56% DV)
    7) Green peas. 1 cup: 3 mg (15% DV)
    8) Grass-fed Beef.
    More items…

  21. azure

    Are there foods that supply B3?

Commenting has been closed for this post.