Indoor Tanning, Skin Cancer and the Young Female Patient: A Review of the Literature.

Young, non-Hispanic white females represent the population most likely to use indoor tanning facilities. This population may be at increased risk of skin cancer as recent meta-analyses support a strong association between cutaneous malignancy and indoor tanning. Public perception of the purported health benefits of indoor tanning may be partially to blame for the popularity of tanning salons as a desire to prepare skin prior to sun exposure is among the most commonly cited motivations for indoor tanning. Improving education and counseling to address misconceptions regarding tanning safety will require the participation of healthcare providers for both physical and psychological screenings as well as for information dissemination. This review presents the association between tanning bed use and skin cancer, biological effects of UV radiation exposure, UV burden associated with tanning devices, public perception of tanning, demographic and psychological profile of indoor tanners, and current legislation regulating tanning bed use.

[1]  Mette Mogensen,et al.  The potential carcinogenic risk of tanning beds : clinical guidelines and patient safety advice , 2010 .

[2]  Sharon A Miller,et al.  UV‐induced DNA damage and melanin content in human skin differing in racial/ethnic origin , 2003, FASEB journal : official publication of the Federation of American Societies for Experimental Biology.

[3]  J. Weeks,et al.  Density of indoor tanning facilities in 116 large U.S. cities. , 2009, American journal of preventive medicine.

[4]  Peter Boyle,et al.  Cutaneous melanoma attributable to sunbed use: systematic review and meta-analysis , 2012, BMJ : British Medical Journal.

[5]  S. Feldman,et al.  Induction of withdrawal-like symptoms in a small randomized, controlled trial of opioid blockade in frequent tanners. , 2006, Journal of the American Academy of Dermatology.

[6]  V. Swope,et al.  α‐MSH tripeptide analogs activate the melanocortin 1 receptor and reduce UV‐induced DNA damage in human melanocytes , 2009, Pigment cell & melanoma research.

[7]  M. Tucker,et al.  Recent trends in incidence of cutaneous melanoma among US Caucasian young adults. , 2008, The Journal of investigative dermatology.

[8]  Ian Jackson,et al.  Variants of the melanocyte–stimulating hormone receptor gene are associated with red hair and fair skin in humans , 1995, Nature Genetics.

[9]  Denise K. Woo,et al.  Tanning beds, skin cancer, and vitamin D: an examination of the scientific evidence and public health implications , 2010, Dermatologic therapy.

[10]  A. Gottlieb,et al.  Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 2. Psoriatic arthritis: overview and guidelines of care for treatment with an emphasis on the biologics. , 2008, Journal of the American Academy of Dermatology.

[11]  Suephy C. Chen,et al.  The melanoma epidemic : Is increased surveillance the solution or the problem ? , 1996 .

[12]  June K. Robinson,et al.  Use of photographs illustrating ABCDE criteria in skin self-examination. , 2009, Archives of dermatology.

[13]  R. Turrisi,et al.  A randomized controlled trial of an appearance‐focused intervention to prevent skin cancer , 2008, Cancer.

[14]  V. Hearing,et al.  Cyclobutane pyrimidine dimer formation and p53 production in human skin after repeated UV irradiation , 2008, Experimental dermatology.

[15]  M. S. Fisher,et al.  Suppressor T lymphocytes control the development of primary skin cancers in ultraviolet-irradiated mice. , 1982, Science.

[16]  J. Simon,et al.  A role for sunlight in skin cancer: UV-induced p53 mutations in squamous cell carcinoma. , 1991, Proceedings of the National Academy of Sciences of the United States of America.

[17]  G. Guy,et al.  Indoor tanning among high school students in the United States, 2009 and 2011. , 2014, JAMA dermatology.

[18]  M. Weinstock,et al.  Indoor Tanning and Risk of Melanoma: A Case-Control Study in a Highly Exposed Population , 2010, Cancer Epidemiology, Biomarkers & Prevention.

[19]  Riccardo Bono,et al.  Dermoscopic Features of Difficult Melanoma , 2007, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].

[20]  B. Gilchrest,et al.  What is all this commotion about vitamin D? , 2010, The Journal of investigative dermatology.

[21]  David E. Fisher,et al.  Central Role of p53 in the Suntan Response and Pathologic Hyperpigmentation , 2007, Cell.

[22]  C. Guinot,et al.  Artificial and natural ultraviolet radiation exposure: beliefs and behaviour of 7200 French adults , 2007, Journal of the European Academy of Dermatology and Venereology : JEADV.

[23]  D. Lazovich,et al.  Preventing skin cancer through reduction of indoor tanning: current evidence. , 2013, American journal of preventive medicine.

[24]  H. Moseley,et al.  Quantitative risk assessment of sunbeds: impact of new high power lamps , 2007, The British journal of dermatology.

[25]  M. Chren,et al.  Indoor tanning and non-melanoma skin cancer: systematic review and meta-analysis , 2012, BMJ : British Medical Journal.

[26]  D. Fisher,et al.  Teens and Indoor Tanning: A Cancer Prevention Opportunity for Pediatricians , 2013, Pediatrics.

[27]  D. Fisher,et al.  Topical drug rescue strategy and skin protection based on the role of Mc1r in UV-induced tanning , 2006, Nature.

[28]  Joshua Schulman,et al.  Indoor ultraviolet tanning and skin cancer: health risks and opportunities , 2009, Current opinion in oncology.

[29]  L. Livi,et al.  Late solitary metastasis of cutaneous malignant melanoma presenting as abnormal uterine bleeding , 2008, The journal of obstetrics and gynaecology research.

[30]  S. Ullrich Mechanisms underlying UV-induced immune suppression. , 2005, Mutation research.

[31]  R. Widome,et al.  Do adolescent indoor tanners exhibit dependency? , 2006, Journal of the American Academy of Dermatology.

[32]  H. Ananthaswamy,et al.  p53 and the pathogenesis of skin cancer. , 2007, Toxicology and applied pharmacology.

[33]  Yau-Huei Wei,et al.  Molecular Mechanisms of UV-Induced Apoptosis and Its Effects on Skin Residential Cells: The Implication in UV-Based Phototherapy , 2013, International journal of molecular sciences.

[34]  C. Potten,et al.  Repeated ultraviolet exposure affords the same protection against DNA photodamage and erythema in human skin types II and IV but is associated with faster DNA repair in skin type IV. , 2002, The Journal of investigative dermatology.

[35]  M. Chren,et al.  International prevalence of indoor tanning: a systematic review and meta-analysis. , 2014, JAMA dermatology.

[36]  Bruce K. Armstrong,et al.  A Prospective Study of Pigmentation, Sun Exposure, and Risk of Cutaneous Malignant Melanoma in Women , 2003 .

[37]  M. Weinstock,et al.  Indoor tanning use among adolescents in the US, 1998 to 2004 , 2009, Cancer.

[38]  Myles G Cockburn,et al.  Increasing burden of melanoma in the United States. , 2009, The Journal of investigative dermatology.

[39]  C. Davis Vitamin D and cancer: current dilemmas and future research needs. , 2008, The American journal of clinical nutrition.

[40]  A. Jemal,et al.  Melanoma in adolescents and young adults (ages 15-39 years): United States, 1999-2006. , 2011, Journal of the American Academy of Dermatology.

[41]  A. Gottlieb,et al.  Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 5. Guidelines of care for the treatment of psoriasis with phototherapy and photochemotherapy. , 2010, Journal of the American Academy of Dermatology.

[42]  U. Wester,et al.  An Analysis of UVA Emissions from Sunlamps and the Potential Importance for Melanoma , 1998, Photochemistry and photobiology.

[43]  A. Luini,et al.  Breast metastases from cutaneous malignant melanoma. , 2004, Breast.

[44]  S. Balk Ultraviolet Radiation: A Hazard to Children and Adolescents , 2011, Pediatrics.

[45]  B. Diffey Sunbeds, beauty and melanoma , 2007, The British journal of dermatology.

[46]  E. Bonar,et al.  Tanning addiction and psychopathology: Further evaluation of anxiety disorders and substance abuse. , 2014, Journal of the American Academy of Dermatology.

[47]  C. Vachon,et al.  Incidence of basal cell and squamous cell carcinomas in a population younger than 40 years. , 2005, JAMA.

[48]  S. Danoff-Burg,et al.  Indoor Tanning, Mental Health, and Substance Use among College Students , 2010, Journal of health psychology.

[49]  J. Majeski Bilateral breast masses as initial presentation of widely metastatic melanoma , 1999, Journal of surgical oncology.

[50]  P. Autier Perspectives in melanoma prevention: the case of sunbeds. , 2004, European journal of cancer.

[51]  B. Gilchrest,et al.  Tanning as part of the eukaryotic SOS response. , 2000, Pigment cell research.

[52]  Kurt Straif,et al.  A review of human carcinogens--part D: radiation. , 2009, The Lancet. Oncology.

[53]  H. Jacobe,et al.  Addictive‐like behaviours to ultraviolet light among frequent indoor tanners , 2011, Clinical and experimental dermatology.

[54]  M. Holick,et al.  Sunscreens suppress cutaneous vitamin D3 synthesis. , 1987, The Journal of clinical endocrinology and metabolism.

[55]  Connie Lim,et al.  Youth risk behavior surveillance - United States, 2011. , 2012, Morbidity and mortality weekly report. Surveillance summaries.

[56]  S. Kanjilal,et al.  Oncogenes and Tumor Suppressor Genes in Photocarcinogenesis , 1996, Photochemistry and photobiology.

[57]  G. Halliday,et al.  Inflammatory Doses of UV May Not Be Necessary for Skin Carcinogenesis † , 2008, Photochemistry and photobiology.

[58]  S. Mayne,et al.  Indoor tanning and risk of early-onset basal cell carcinoma. , 2012, Journal of the American Academy of Dermatology.

[59]  D. Rigel,et al.  Adverse effects of ultraviolet radiation from the use of indoor tanning equipment: time to ban the tan. , 2011, Journal of the American Academy of Dermatology.

[60]  June K. Robinson,et al.  Indoor tanning knowledge, attitudes, and behavior among young adults from 1988-2007. , 2008, Archives of dermatology.

[61]  R. Hornung,et al.  Tanning facility use: are we exceeding Food and Drug Administration limits? , 2003, Journal of the American Academy of Dermatology.

[62]  W. Ting,et al.  Tanning bed exposure increases the risk of malignant melanoma , 2007, International journal of dermatology.

[63]  Cheng-Ta Lai,et al.  Anal Malignant Melanoma , 2012 .

[64]  Lisa M. Schwartz,et al.  Skin biopsy rates and incidence of melanoma: population based ecological study , 2005, BMJ : British Medical Journal.

[65]  H. Adami,et al.  Host characteristics, sun exposure, indoor tanning and risk of squamous cell carcinoma of the skin , 2014, International journal of cancer.

[66]  H. Brumberg,et al.  Technical report - Ultraviolet radiation , 2011 .

[67]  D. Siegel,et al.  The indoor UV tanning industry: a review of skin cancer risk, health benefit claims, and regulation. , 2005, Journal of the American Academy of Dermatology.

[68]  A. Favier,et al.  Cyclobutane pyrimidine dimers are predominant DNA lesions in whole human skin exposed to UVA radiation , 2006, Proceedings of the National Academy of Sciences.

[69]  G. Mcneer MALIGNANT MELANOMA. , 1965, Surgery, gynecology & obstetrics.

[70]  S. Feldman,et al.  Tanning as an addictive behavior: a literature review , 2009, Photodermatology, photoimmunology & photomedicine.

[71]  S. Woodruff,et al.  Compliance with federal and state legislation by indoor tanning facilities in San Diego. , 2001, Journal of the American Academy of Dermatology.

[72]  A. Ziegler,et al.  Sunlight and sunburn in human skin cancer: p53, apoptosis, and tumor promotion. , 1996, The journal of investigative dermatology. Symposium proceedings.

[73]  K. Hemminki,et al.  Protective Effects of Tanning on Cutaneous DNA Damage in situ , 2001, Dermatology.

[74]  William D James,et al.  Indoor tanning--science, behavior, and policy. , 2010, The New England journal of medicine.

[75]  K. Wakamatsu,et al.  Pigmentation effects of solar‐simulated radiation as compared with UVA and UVB radiation , 2008, Pigment cell & melanoma research.

[76]  A. Al Samaraee,et al.  Breast metastasis from a melanoma. , 2012, The Ochsner journal.

[77]  C. Rodríguez-Galindo,et al.  Trends in incidence of primary cutaneous malignancies in children, adolescents, and young adults: A population‐based study , 2014, Pediatric blood & cancer.

[78]  R. Hornung,et al.  Tanning Device Usage: What Are Parents Thinking? , 2007, Pediatric dermatology.

[79]  P. Mathys,et al.  Ultraviolet Emission Spectra of Sunbeds¶ , 2002 .

[80]  Jenine K. Harris,et al.  Incidence of Childhood and Adolescent Melanoma in the United States: 1973–2009 , 2013, Pediatrics.

[81]  A. Bleyer,et al.  Cancer epidemiology in older adolescents and young adults 15 to 29 years of age, including SEER incidence and survival: 1975-2000. , 2006 .

[82]  G. Belch,et al.  Promotion of frequent tanning sessions by indoor tanning facilities: two studies. , 2002, Journal of the American Academy of Dermatology.

[83]  D. Albanes,et al.  A prospective nested case-control study of vitamin D status and pancreatic cancer risk in male smokers. , 2006, Cancer research.

[84]  G. Halliday,et al.  B cells activated in lymph nodes in response to ultraviolet irradiation or by interleukin-10 inhibit dendritic cell induction of immunity. , 2005, The Journal of investigative dermatology.

[85]  G. Kaygusuz,et al.  Abnormal uterine bleeding as a presenting sign of metastasis to the endometrium in a patient with a history of cutaneous malignant melanoma. , 2004, Gynecologic oncology.

[86]  V. Hearing,et al.  UVA tanning is involved in the increased incidence of skin cancers in fair‐skinned young women , 2010, Pigment cell & melanoma research.

[87]  Melody J Eide,et al.  Update on the current state of melanoma incidence. , 2012, Dermatologic clinics.

[88]  Ryan E O'Leary,et al.  Update on tanning: More risks, fewer benefits. , 2014, Journal of the American Academy of Dermatology.

[89]  M. Holick,et al.  Tanning is associated with optimal vitamin D status (serum 25-hydroxyvitamin D concentration) and higher bone mineral density. , 2004, The American journal of clinical nutrition.

[90]  A. Yaroch,et al.  Measurement of tanning dependence , 2014, Journal of the European Academy of Dermatology and Venereology : JEADV.

[91]  T. Schwarz 25 years of UV‐induced Immunosuppression Mediated by T Cells—From Disregarded T Suppressor Cells to Highly Respected Regulatory T Cells † , 2007, Photochemistry and photobiology.

[92]  B. Benacerraf,et al.  Impairment of antigen-presenting cell function by ultraviolet radiation. , 1979, Proceedings of the National Academy of Sciences of the United States of America.

[93]  B. Gilchrest Sun exposure and vitamin D sufficiency. , 2008, The American journal of clinical nutrition.

[94]  J. Cadet,et al.  Direct and indirect effects of UV radiation on DNA and its components. , 2001, Journal of photochemistry and photobiology. B, Biology.

[95]  J. Hillhouse,et al.  The effect of initial indoor tanning with mother on current tanning patterns. , 2010, Archives of dermatology.

[96]  G. Halliday,et al.  Ultraviolet A radiation: its role in immunosuppression and carcinogenesis. , 2011, Seminars in cutaneous medicine and surgery.

[97]  J. Krueger,et al.  Suberythemogenic narrow-band UVB is markedly more effective than conventional UVB in treatment of psoriasis vulgaris. , 1999, Journal of the American Academy of Dermatology.

[98]  P. Calzavara-Pinton,et al.  Narrow band UVB (311 nm) phototherapy and PUVA photochemotherapy: a combination. , 1998, Journal of the American Academy of Dermatology.

[99]  R. Turrisi,et al.  A comparison of the efficacy of an appearance-focused skin cancer intervention within indoor tanner subgroups identified by latent profile analysis , 2010, Journal of Behavioral Medicine.

[100]  S. Ullrich,et al.  The Immunologic Revolution: Photoimmunology , 2011, The Journal of investigative dermatology.