With summer around the corner and graduation season in full swing, now is the time to remind patients to skip the tanning booth.
Tanning salons may sound like a throwback in this era of increased awareness about the damaging effects of ultraviolet (UV) radiation and its association with melanoma, the deadliest form of skin cancer. Evidence of the damaging effects of UV radiation is so overwhelming that in 2009, the World Health Organization declared it a Group 1 carcinogen. Yet, a 2020 Memorial Sloan Kettering Cancer Center study of indoor tanning among U.S. adults shows that, while indoor tanning has decreased in popularity in recent years, millions of Americans each year are still being exposed to artificial UV radiation in tanning salons.
The most common users of tanning salons are young white women, with nearly a third of those ages 18-25 reporting visits in the past year. Use of indoor tanning beds before age 35 increases the lifetime risk of developing melanoma by 75%, and melanoma is the number one cause of cancer-related death in young white women ages 25-30. Meanwhile, social media feeds are still abuzz with “tanning tips for prom” and videos of tanning competitions.
For me, melanoma is both professional and personal. I lost my aunt Val, a 33-year-old nurse, and my cousin Rob, a 37-year-old father of two, to skin cancer. And every week in the research lab where I work on melanoma treatments, I meet young patients with skin cancer. During our conversations I always ask about UV protection and indoor tanning. About a third tell me they used to go to tanning booths. Some have been to a tanning salon over 100 times.
“Nobody ever told me,” a mother in her early 30s with a diagnosis of stage IV melanoma said recently. The cancer had spread to her lymph nodes and beyond, and she was undergoing systemic immunotherapy with her oncologist. She had started tanning at age 16. “I am in shock,” she told me. “I wish I had known how dangerous tanning is.” Five-year survival for stage IV melanoma is around 35%.
Along with skin cancer, UV radiation causes premature skin aging and can accelerate the breakdown of collagen and elastin that confer elasticity and tightness to the skin, resulting in sagging and wrinkling. UV radiation exposure from tanning booths — which can provide twice the amount of UVB and 12-times-higher levels of UVA compared with natural sun — also stimulates the accumulation of the pigment melanin in skin cells, which can cause lentigines and aggravate chronic skin conditions such as cutaneous lupus and rosacea.
Interestingly, indoor tanning bears some similarities to a controlled substance that causes addictive behavior: UV exposure promotes the release of endorphins in the skin, causing a feeling of well-being that makes it more difficult to stop.
Amid all the evidence pointing to the risks of indoor tanning, some countries have taken action. Australia and Brazil have outright banned all indoor tanning, citing the evidence of harm.
In the U.S., regulation of indoor tanning has been left to individual states. Currently, 20 states and Washington, DC have passed laws completely banning the use of commercial tanning devices for anyone under 18. Another 24 states have at least some restrictions on minors’ use of commercial tanning devices. Meanwhile, other states allow minors as young as 15 to use tanning salons. However, these bans have not been very effective. A Yale study showed that in 20% of cases, the tanning ban for minors was not enforced, and researchers posing as minors were able to schedule tanning sessions by phone in some cases despite the partial ban.
A group of international researchers in 2020 calculated that a no-exception ban on indoor tanning for everyone ages 12-35 in North American would prevent an estimated 244,000 melanoma cases and 89,000 deaths, and save $30 billion (in healthcare costs and productivity) over the next 50 years, while banning the practice for minors would provide one third of those benefits.
In 2015, the FDA proposed a rule to restrict individuals under 18 from using tanning salons, but the proposal was never implemented. Numerous political barriers have delayed it, from apparent opposition and lobbying by the $5 billion-a-year tanning industry to arguments that youth access laws are a restriction of parents’ civil liberties.
What can you do to help protect your patients? You can write to your representatives asking them to support the FDA-proposed no-exception federal ban on tanning for minors, or sign the Skin Cancer Foundation’s petition. And you can encourage patients to reconsider by discussing the risks. A study from the Rutgers Cancer Institute reported that simply asking tanners to reflect on their reasons caused some to stop using tanning beds, by challenging their beliefs about the benefits of indoor tanning. For instance, some incorrectly believe that indoor tanning is a safe way to get vitamin D. But this is clearly a misconception.
It’s high time to regulate tanning salons and better protect our patients. The “bronzed look” is not worth the extreme long-term health risks.
Goran Micevic, MD, PhD, is a dermatologist and biomedical scientist with over 10 years of experience in melanoma research. He is a Public Voices fellow of The OpEd Project in partnership with the Paul and Daisy Soros Foundation.
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