Friday, May 14, 2010

There’s No Safe Tan

Indoor tanning comes under fire

David Fisher, MD, PhD

The recent warm weather has New Englanders pulling their shorts and flip flops out of storage. But what if you want a bronze glow to go with the summer attire? Doctors warn that heading to the tanning salon is not a safe choice.

For years, dermatologists have warned about the damaging effects of the UV lights used in indoor tanning salons, citing a dangerous connection between tanning beds and cancer.

"There are crystal-clear, validated studies that support a connection between indoor tanning and major skin cancers, including melanoma," says David Fisher, MD, PhD, chief of dermatology at Massachusetts General Hospital and an outspoken opponent of the tanning industry. "One large study demonstrated a 75 percent increased risk of melanoma among young women under the age of 35 who use tanning salons."

Restrictions needed

Based on the mountain of evidence of the health risk, the U.S. Food and Drug Administration recently set its spotlight on the indoor tanning industry.  

Dr. Fisher was among the experts who testified before the panel, urging them to consider placing restrictions on the tanning industry.

"The existing regulations around indoor tanning bed access are extremely lax. In many states there is open access to this service," he says. "There is open access to minors despite the fact that the FDA's own website lists UV radiation as carcinogenic."

Tanning beds are currently rated as Class I medical devices — the same category as tongue depressors and band aids — which carry few, if any, restrictions. A FDA advisory panel recommended re-classifying the beds as Class II or Class III devices, which would give the agency authority to regulate their use, particularly among minors, by banning them or requiring parental consent.

Addicted to tanning

Despite the overwhelming data available about the danger of tanning, use of indoor tanning services among adolescents and young adults continues to rise.

A new study, published in the Archives of Dermatology, surveyed more than 400 college students and found that more than half had used a tanning salon. Using a modified questionnaire that gauges drug and alcohol abuse, researchers also determined that many of those people met the criteria for tanning addiction.  The "addicted" students tanned more frequently than others, and they were also more likely to have symptoms of anxiety and use alcohol and drugs.

No tan is safe

Is there a safe tan? Dr. Fisher says no. Mass General researchers found that creating pigment — which causes skin to darken — is caused by damaging DNA. This is the same process by which cancer cells develop.

"If there is a tan there has to be DNA damage, and with that comes the risk of skin cancer," says Dr. Fisher. "The safe tan argument has lost all of its merit."

Tanning more than doubles the risk of developing all types of skin cancers, including melanoma.  Melanoma is caused when cancer cells develop in the melanocytes, the cells that produce skin's pigment. Although not as common as basal cell or squamous cell cancers, it is responsible for the majority of deaths from skin cancer.

This high death rate is because melanoma is extremely invasive. For instance, a melanoma lesion less than 1 mm is depth is considered early stage cancer. In comparison, lesions 1 cm (10-times as large) are consider early stage for other types of cancers, like breast, lung and colon cancer.

"There's something intrinsic to melanoma that makes it particularly adept at invading and colonizing," says Dr. Fisher.

What is less known is that non-melanoma cancers can also be fatal. About quarter of all skin cancer deaths result from non-melanoma cancers. This translates to thousands of deaths per year.

UV radiation is capable of causing skin darkening — and thereby DNA damage and increased cancer risk — for all skin colors. However, the dose of UV needed to tan skin varies among people of different skin colors. For example, those who tan easily will have less DNA damage than those who are trying harder to tan.

"Unfortunately people who tan poorly are precisely the ones who 'try harder' to tan, and thus elevate their risk," says Dr. Fisher.

Avoiding UV radiation by staying out of the sun and using sunscreen is the best protection. Early detection is important in treating all skin cancers. The ABCD is a helpful tool in recognizing changes in moles that could be signs of skin cancers. The warning signs are:
  • Asymmetry - when half of the mole does not match the other half
  • Border - when half of the mole does not match the other half
  • Color - when the color of the mole varies throughout
  • Diameter - if the mole's diameter is larger than a pencil's eraser

For more information about skin cancer and treatments, visit the Mass General Melanoma Center and Pigment Lesion Center.

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