By Sarah E. Schram, MD / Mohs Surgeon, Cosmetic Dermatologist

There is new hope to those at high risk of developing the most common types of skin cancer and the key may be an over-the-counter vitamin supplement that costs less than $10 a month. Nicotinamide (a form of Vitamin B3) has been shown in recent studies to reduce the risk of both actinic keratoses (precancers) and non-melanoma skin cancers. Ultraviolet light causes damage to the DNA of our cells, necessitating repair that depletes cellular energy. Nicotinamide helps to replenish this energy, thus improving the rate of DNA repair and decreasing cellular immunosuppression. Taking nicotinamide 500mg by mouth twice daily led to a 35% reduction in actinic keratoses in one study (Surjana et al. 2012). Another study showed that in patients who have had at least two non-melanoma skin cancers in the last five years, there was a 23% reduction in development of new basal cell and squamous cell carcinoma compared to the placebo (Chen 2015).

While there is not enough data yet to suggest that all people should take nicotinamide, if you have a history of skin cancer, it may be helpful to decrease the risk of developing more.  Nicotinamide is contained in many foods such as beans, meat, fish, eggs, milk and cereals but to reasonably get to the doses reported in the study, a supplement would need to be used.  The dosing recommended by the study is 500mg twice daily.  At this dose, very few side effects were reported.

Surjana D, Halliday GM, Martin AJ, Moloney FJ, Damian DL. Oral Nicotinamide reduces actinic keratoses in phase II double-blinded randomized controlled trials.  J Invest Dermatol  2012;132: 1497-500.
Chen AC, Martin AJ, Choy B, et al. A phase 3 randomized trial of nicotinamide for skin cancer chemoprevention.   N Engl J Med 2015;373:1618-26.

Not Just “Lip Service”: Real Lip Rejuvenation

Gerald N. Goldberg, MD – Medical Director, C0-Owner, Pima Dermatology

“Smoker’s lines”, around the lips and mouth, are a common concern for many of us. They are the deep vertical lines above and below the lip margin, often caused by sun damaged skin and repeated muscle movement. These lines are accelerated and worsened by smoking and other “puckering” activities involving the mouth musculature, such as smoking and sipping with a straw.

Line remedies exist and there are some excellent treatment alternatives that can be tailored and customized to achieve significant cosmetic improvement. In looking for a natural, more healthy and youthful appearance, it is important to define your goals, budget, and what steps you are willing to take to achieve them. Do you want a one-time, fairly aggressive treatment, or a more modest, incremental, stepwise series of treatments to reach your aesthetic goals?

Minimal downtime treatments can be achieved in-office with injectable dermal fillers or a series of low downtime Laser treatments done monthly over a period of months. A wide-range of dermal fillers made from hyaluronic acid, a product identical to skin’s dermal makeup, are available. The latest offering is Volbella®, used to achieve a softening and smoothing of lip wrinkles and subtle volume, with minimal downtime and very natural-looking results. Dermal fillers can be injected safely and relatively comfortably. Side-effects can include some mild swelling after injection with the possibility of bruising lasting a few days. Price range is $450 – $500 per syringe and typically requires 1 to 2 syringes for desired correction.

Minimal downtime Laser treatments are usually performed by aesthetic staff under topical anesthesia or no anesthesia at all. Laser Skin Toning is performed with warm infrared light, and has the least downtime, with modest redness and swelling for a few days. This treatment is repeated at monthly or bimonthly intervals. Pricing is $195 – $495 per session.

A more intense Laser treatment can be done with a Fractional Erbium Laser, such as the StarLux® or the Sciton® Halo™. These devices are also employed by aesthetic staff under topical or no anesthesia, and are typically done in combination with full facial treatment, which involves a sunburn-like reaction and peeling for several days post treatment. These  sessions can also be focused solely around the mouth and repeated at intervals to achieve an optimal effect. A consultation will provide pricing based on areas treated, typically $600 – $1500 per treatment.

The most aggressive lip line remedy is with the ablative Lasers, such as the Sciton® Profractional™ or DOT® carbon dioxide Lasers. These Lasers are used in combination with topical anesthesia, mild sedation, and at times anesthetic blocks (like numbing at the dentist). Performed by physicians, these lasers can involve up to a week or more of healing time, but often achieve the most dramatic effects. Full Face Laser Skin Resurfacing ranges from $2100 and up. For lip lines only, the price is less and can be determined at your consultation.

For more information, please view our website at or call to schedule a consultation at 520.795.7729.

Photo Credit: Gerald N. Goldberg, MD