This JAMA Dermatology looks at the the Association Between Indoor Tanning and Melanoma in Younger Men and Women


This study was a Population-based case-control study conducted in Minnesota of 681 patients (465 [68.3%] women) diagnosed as having melanoma between 2004 and 2007, and 654 controls (446 [68.2%] women), ages 25 to 49 years.

The study particularly looked at

Exposure Indoor tanning, defined as any use, first age of use, and total sessions.

Results Compared with women aged 40 to 49 years, women younger than 40 years initiated indoor tanning at a younger age (16 vs 25 years, P < .001) and reported more frequent indoor tanning (median number of sessions, 100 vs 40, P < .001). Women younger than 30 years were 6 times more likely to be in the case than the control group if they tanned indoors (crude OR, 6.0; 95% CI, 1.3-28.5). Odds ratios were also significantly elevated among women, ages 30 to 49 years (adjusted OR, 3.5; 95% CI, 1.2-9.7 for women 30-39 years; adjusted OR, 2.3; 95% CI, 1.4-3.6 for women 40-49 years); a dose response was observed among women regardless of age. Among men, results by age were inconsistent. The strongest OR for indoor tanning by anatomic site was for melanomas arising on the trunk of women (adjusted OR, 3.7; 95% CI, 1.9-7.2).

The study concluded that  Indoor tanning was  a likely factor for the steepincrease in melanoma rates in Minnesota and extrapolated this across the United States particularly with regard to young women.

JAMA Dermatol. 2016;152(3):268-275. doi:10.1001/jamadermatol.2015.2938

Background information from the article includes

The US incidence of melanoma has been increasing over the past several decades. In 2016, it is estimated that 76 380 individuals will be diagnosed with invasive melanoma and 10 130 will die of the disease.1 Melanoma represents a small fraction (<5%) of incident skin cancers, yet accounts for an estimated 75% of skin cancer deaths. Even though the incidence of most solid tumors decreased between 1975 and 2012, the incidence of melanoma increased approximately 3% per year.2 Between 2002-2006 and 2007-2011, the average annual cost for melanoma treatment increased nearly 3-fold (from an estimated $0.86 billion to $3.35 billion).2

Overexposure to the sun and use of indoor tanning devices contributes to the majority of melanomas and nonmelanoma skin cancers. The causal role of UV radiation (UVR) is supported by high rates of UVR-associated somatic mutations in the majority of melanomas.3 Although the specific timing, wavelengths, and doses of UVR exposure that cause melanoma are not fully defined, some data suggest that sunburns during childhood are particularly harmful, and sunburns throughout life also contribute to risk.4 Moreover, data show that US sunburn rates are high, and more than half of high school students and young adults report having been sunburned during the past year.5 The World Health Organization’s International Agency for Research on Cancer added UVR-emitting tanning devices to its list of class I carcinogens and has indicated that melanoma risk was greater with exposure to indoor tanning devices before the age of 35 years.6 In recognition of the critical role of UVR exposure as a cause of skin cancer, the US Surgeon General issued a Call to Action to Prevent Skin Cancer in 2014 that provides an actionable framework for skin cancer prevention efforts, noting that most cases are potentially preventable.4

In a recent case-control study published in JAMA Dermatology, Lazovich and colleagues7 found that 61 of 63 women (97%) diagnosed as having melanoma before the age of 30 years and 132 of 140 women (94%) diagnosed between the ages of 30 and 39 years had engaged in indoor tanning, starting at a median age of 16 years, with a median of greater than 100 tanning sessions; 184 of these 193 women (95%) initiated indoor tanning before the age of 25 years. This study by Lazovich et al is the most recent to document increased melanoma risks associated with indoor tanning and provides some of the most compelling evidence demonstrating that age at tanning onset is a factor related to melanoma development, especially among people who tan indoors at a young age, more frequently, or both. The findings complement an Australian population-based study estimating that 76% of melanomas diagnosed between the ages of 18 and 29 years among those who ever used a sunbed (tanning bed) were associated with sunbed use.8

According to the 2013 National Health Interview Survey, an estimated 7.8 million US adult females and 1.9 million males used indoor tanning devices in 2013.5 Indoor tanning is frequent among younger people; the 2013 Youth Risk Behavior Survey (YRBS) found that 20.2% of US high school female students and 5.3% of male students reported indoor tanning at least once during the 12 months before the survey.5 More than half the students were classified as “frequent tanners” (≥10 times within past year).9 According to the 2015 YRBS, overall reported use decreased to 10.6% and 4.0% among high school females and males, respectively, which represents a significant decrease from 2013. Across the 2009-2015 YRBS, an overall significant decrease in the prevalence of indoor tanning was observed (from 15.6% to 7.3% overall, and among high school female students, from 25.4% to 10.6%).5

In a June 2015 JAMA Viewpoint, Mays and Kraemer called for US public health experts and health care professionals to advocate for indoor tanning prevention policies at the state and local levels. Noting that young adults may also have access to indoor tanning on or near campus, they opined that colleges and universities could implement “tan-free” policies by adapting approaches that have been successful for tobacco control. Later in 2015, the University of Texas MD Anderson Cancer Center developed and disseminated a Skin Cancer Prevention Toolkit for institutions of higher education to foster college and university leaders to adopt, implement, and enforce campus skin cancer prevention policies and practices.2

Because of the risks associated with indoor tanning, state and federal policies have been implemented to restrict indoor tanning among minors. In 2012, California became the first state to ban indoor tanning for individuals younger than 18 years. As of September 2016, 15 states and the District of Columbia have passed indoor tanning bans for individuals younger than 18 years; 43 states have enacted at least some legislation restricting use by minors.2,5 The US Food and Drug Administration (FDA) regulates UV tanning devices. Although these devices were previously categorized as low-risk class I medical devices, in May 2014 they were reclassified as moderate-risk class II devices.4 In December 2015, the FDA announced a proposed rule to restrict the use of indoor tanning to people older than 18 years and will require users to acknowledge they have been informed about health risks and to repeat this acknowledgment every 6 months thereafter.5

Despite the advances made in the treatment of metastatic melanoma, this disease is still potentially lethal and is associated with life-altering consequences for survivors and significant costs to society. Societal norms value the appearance of a suntan, despite the dangers of melanoma associated with sun tanning. Artificial, indoor tanning presents a particularly high risk for development of melanoma, especially for young people. Recent reductions among minors after multiple states enacted indoor tanning restrictions for individuals younger than 18 years suggest that further reductions in indoor tanning use can be anticipated if additional restrictions are put in place, and further awareness of the dangers is promulgated. In addition to promoting sun protection to reduce UVR overexposure throughout life, access to tanning beds by minors should be restricted and indoor tanning businesses should be regulated to reduce the risk of melanoma among users of these facilities.