Skin Cancer Prevention · Alaska

Lowering Your Skin Cancer Risk: A Dermatologist's Evidence-Based Guide for Alaskans

From daily sun protection to a vitamin you can buy at any pharmacy, here is what actually has evidence behind it for reducing skin cancer, and where prescription options fit in.

Alaskans aren't immune to skin cancer, far from it. Long summer days, high-altitude and on-the-water UV exposure, snow that reflects sunlight back at you in winter, and a population that spends real time outdoors all add up. The good news: skin cancer is one of the most preventable cancers there is, and several of the most effective steps are simple, inexpensive, and available today.

Below, we walk through the prevention strategies we discuss with patients at Advanced Dermatology of Alaska, roughly in the order of how strong the evidence is and how broadly they apply. As always, the right plan for you depends on your personal history, especially if you've already had a skin cancer or a transplant.

1. Sun protection comes first

The foundation everything else builds on

Ultraviolet radiation is the single largest modifiable cause of skin cancer. Nothing on this page replaces good sun protection; the supplements and medications below are additions to it, not substitutes. A practical, year-round approach for Alaska looks like this:

• Broad-spectrum SPF 30 or higher, applied generously to exposed skin and reapplied every two hours outdoors (and after swimming or sweating). Most people apply far too little. About a full shot-glass amount covers the body.
• Don't forget winter and water. Snow reflects a large share of UV back onto your face, and reflection off lakes and the ocean does the same in summer. Lips, ears, and the back of the neck are commonly missed.
• Sun-protective clothing, wide-brimmed hats, and UV-blocking sunglasses do work sunscreen can't, and you never have to reapply them.
• Seek shade during peak hours, and remember that UV exposure adds up over a lifetime, so every bit you block counts.

Regular professional skin exams and at-home self-checks round out the foundation. Finding a skin cancer early, especially melanoma, dramatically changes outcomes.

2. Niacinamide (vitamin B3), 500 mg twice dailyClinical trial evidence

An inexpensive supplement with real data behind it

Niacinamide, also called nicotinamide (a form of vitamin B3), is one of the few over-the-counter supplements with randomized-trial evidence for reducing non-melanoma skin cancer. It works by boosting the energy cells need to repair UV-damaged DNA and by blunting the immune suppression that UV light causes in skin.

The landmark study, known as the ONTRAC trial (published in the New England Journal of Medicine in 2015), enrolled 386 people who had already had at least two non-melanoma skin cancers in the prior five years. Those taking niacinamide 500 mg twice daily for a year had about a 23% lower rate of new non-melanoma skin cancers (basal cell and squamous cell carcinomas) compared with placebo, along with fewer actinic keratoses (precancerous spots).

Niacinamide is generally well tolerated. Talk with us before starting if you have kidney or liver concerns, are pregnant, or take other supplements, so we can confirm it's appropriate for you.

3. Polypodium leucotomosSupportive, modest evidence

A plant-derived "internal" photoprotectant, but not a replacement for sunscreen

Polypodium leucotomos is an extract from a tropical fern, sold over the counter as an oral antioxidant photoprotectant (the most-studied formulation is branded Fernblock/Heliocare). In human studies it has been shown to reduce the redness and cellular UV damage that follow sun exposure, which is why some dermatologists suggest it for patients who are very sun-sensitive or at higher skin cancer risk.

The honest framing matters here: the evidence is promising but more limited than for niacinamide, and it is mostly about reducing markers of UV damage rather than long-term cancer counts. It is best thought of as a possible add-on for higher-risk or photosensitive patients, never as a substitute for sunscreen, clothing, and shade. If you'd like to try it, we can talk through whether it fits your situation.

4. Prescription options for high-risk patientsBy prescription

Reserved for select patients, with monitoring

Acitretin (oral retinoid)

Acitretin is an oral retinoid (a vitamin A derivative) that can reduce the formation of new squamous cell carcinomas in patients at very high risk, for example organ-transplant recipients and people who develop numerous skin cancers. It can be effective, but it carries meaningful considerations: it is strictly off-limits in anyone who could become pregnant (it causes severe birth defects and stays in the body for a long time), and it requires monitoring of cholesterol, triglycerides, and liver function. The benefit also tends to fade once the medication is stopped. For the right patient, though, it's a valuable tool, and one we manage closely.

Other approaches we may discuss

Depending on your history, we may also talk about treating precancerous spots directly (for example, topical field therapies for widespread actinic keratoses), nicotinamide combined with diligent surveillance, or other strategies tailored to your skin. For non-melanoma skin cancers that do develop, options at our practice range from Mohs micrographic surgery, the gold standard for many facial skin cancers, to non-surgical GentleCure (image-guided superficial radiation therapy) for appropriate cases.

Building your personal prevention plan

No two patients have the same risk. Someone with fair skin and a few past sunburns needs a different plan than a transplant recipient or someone who's already had several skin cancers. A good starting framework:

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