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While nicotine itself is not considered to be carcinogenic, each cigarette contains a mixture of carcinogens, including a small dose of polycyclic aromatic hydrocarbons (PAHs) and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) among other lung carcinogens, tumor promoters, and co-carcinogens

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The cornerstone of management is dose titration (start low, go slow)

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Zou FM, Lee KS, Kim BY, Kim HJ, Gui ZZ, Zhang GZ, Guo X, Jin BR (2015) Differential and spatial regulation of the prophenoloxidase (proPO) and proPO-activating enzyme in cuticular melanization and innate immunity in Bombyx mori pupae