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Preventing Skin Cancer Caused by Indoor Tanning Devices

Health Letter, November 2014

By J. Timothy Sprehe

Each year, thousands of Americans frequent tanning salons or use sunlamp products. But prolonged use of these devices can lead to skin cancers, the deadliest form of which is melanoma. Both Surgeon General Boris Lushniak and the Food and Drug Administration (FDA) have called for new actions to reduce skin cancers, especially those caused by indoor tanning businesses such as tanning salons and appliances such as sunlamps. The Surgeon General’s Call to Action to Prevent Skin Cancer, released July 29, discusses these dangers and the strategies it will implement to prevent future cases of the disease.[1]

Tanning and skin cancer

Tanned skin is damaged skin, according to the FDA’s Sharon Miller, an international expert on ultraviolet (UV) radiation and tanning. “A tan is the skin’s reaction to exposure to UV rays,” says Miller. “Recognizing exposure to the rays as an ‘insult,’ the skin acts in self-defense by producing more melanin, a pigment that darkens the skin. Over time, this damage will lead to prematurely aged skin and, in some cases, skin cancer.”[2] According to the American Cancer Society (ACS), no skin tan is a safe tan, whether acquired indoors or outdoors.[3] Indoor tanning is particularly dangerous because of its enhanced likelihood for causing skin cancer, including the deadly melanoma.

Skin cancer is the most commonly diagnosed and also the most preventable cancer in the nation. It greatly affects quality of life and can lead to disfigurement and even death. Each year, almost 5 million Americans receive skin cancer treatment at a combined cost of more than $8 billion.[4] Nearly 13,000 people die each year from skin cancers, and almost 10,000 of those deaths are from melanoma, according to the ACS. The organization predicts that in 2014, melanoma will account for over 76,000 cases of skin cancer.[5]

Both the World Health Organization and the American Academy of Dermatology state that people exposed to UV radiation via indoor products increase their risk of developing melanoma by 59 percent, and the risk rises with each use.[6] Users of these products also are susceptible to eye injury and premature aging of the skin.

Young people especially at risk

The danger from indoor tanning devices is greatest to adolescents. An especially critical group is late adolescent females, who show the greatest propensity for use of indoor tanning. In 2013 prevalence of indoor tanning use was highest among 11th and 12th grade females (23 and 27.2 percent, respectively) as compared with all other age and sex groups.[7] Young women in their late adolescence are particularly prone to seek out tanning salons and tanning beds if their mothers have used them and if their peers are frequenting them.

In 2012, California legally banned the use of indoor tanning devices by those age 18 or younger. By January 2014, six states had instituted such prohibitions. In all, 33 states place some form of age restriction on UV tanning devices.[8] While some studies have shown state laws to be ineffective deterrents to underage use of UV lamps, a recent study found that more than three-quarters of California’s indoor tanning facilities were in compliance with the state law forbidding use of the facilities by teenagers. Still, state officials’ views are far from unanimous on this subject. In April 2013, the governor of Maine vetoed a law to restrict teenage use of tanning devices, calling it “government run amok.”[9]

Five goals for skin cancer prevention

The surgeon general’s call to action sets five strategic goals to support skin cancer prevention in the U.S.[10] The first goal is to increase opportunities for sun protection in outdoor settings through measures such as increasing shade in outdoor recreational settings and increasing sun protection for outdoor workers.

Means for achieving goal number two — to provide individuals the information needed for healthy choices about UV exposure — include developing effective messages for specific audiences, such as schools, as well as building partnerships with health care systems and providers. Public- and private-sector partnerships could also disseminate effective skin cancer messages.

The surgeon general’s third strategic goal centers on promoting policies to advance the prevention of skin cancer. Tools involve including sun protection guidance not only in school policies but also in school facilities construction and in curricula, promoting electronic reporting of skin cancers among health care providers and systems, and making sun safety an element of workplace policies and safety trainings.

The fourth goal is to reduce the harms from indoor tanning. Measures to reduce harms begin with studying the attitudes, beliefs and behaviors of Americans who tan indoors, especially youth and parents. Other aims under this goal include continued efforts to reduce indoor tanning among populations at high risk, enforcement of existing indoor tanning laws and possible adoption of additional restrictions.

Finally, the Surgeon General would like to strengthen research, monitoring and evaluation of skin cancer prevention. Ways to achieve this goal include increasing understanding of the seriousness of skin cancer and UV radiation and measuring the prevalence of skin tanning in unsupervised locations.

Working together for health

Partners in prevention from various sectors across the United States must address skin cancer as a major public health problem, according to the Surgeon General. Federal, state, tribal, local and territorial governments; members of the business, health care and education sectors; community, nonprofit and faith-based organizations; and individuals and families are all essential partners in this effort.[11]

“As both a medical doctor and a public health official, I see that now is the time for a comprehensive approach to prevent skin cancer, bringing together community partners, business leaders, government agencies, and individuals for a common cause,” stated the Surgeon General in releasing the call to action.


[1] U.S. Surgeon General. The Surgeon General’s Call to Action to Prevent Skin Cancer. Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General; 2014. http://www.surgeongeneral.gov/library/calls/prevent-skin-cancer/exec-summary.html. Accessed August 12, 2014.

[2] Food and Drug Administration. Indoor tanning: The risk of ultraviolet rays. Updated May 29, 2014. http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm186687.htm.

[3] American Cancer Society. Indoors or outdoors, there’s no such thing as a safe tan. May 22, 2014. http://www.cancer.org/cancer/news/expertvoices/category/skin-cancer.aspx. Accessed August 3, 2014.

[4] Food and Drug Administration. FDA to require warnings on sunlamp products. May 29, 2014. http://www.fda.gov/newsevents/newsroom/pressannouncements/ucm399222.htm.

[5] American Cancer Society. What are the key statistics about melanoma skin cancer? Updated September 5, 2014. http://www.cancer.org/cancer/skincancer-melanoma/detailedguide/melanoma-skin-cancer-key-statistics. Accessed September 18, 2014.

[6] American Academy of Dermatology. Indoor Tanning. http://www.aad.org/media-resources/stats-and-facts/prevention-and-care/indoor-tanning. Accessed August 12, 2014.

[7] Centers for Disease Control and Prevention. Indoor tanning use. Morbidity and Mortality Weekly Report, Surveillance Summaries. June 13, 2014;63(4). See also, Guy GP. Outdoors or indoors: There’s no such thing as a safe tan. http://www.cancer.org/cancer/news/expertvoices/post/2014/05/22/indoors-or-outdoors-theres-no-such-thing-as-a-safe-tan.aspx. Accessed October 19, 2014.

[8] Indoor tan bans. State Legislatures Magazine. June 2013. http://www.ncsl.org/bookstore/state-legislatures-magazine/trends-and-transitions-june-2013.aspx. Accessed September 29, 2014.

[9] Ibid.

[10] U.S. Surgeon General. The Surgeon General’s Call to Action to Prevent Skin Cancer. Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General; 2014. http://www.surgeongeneral.gov/library/calls/prevent-skin-cancer/exec-summary.html. Accessed August 12, 2014.

[11] Ibid.