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WHO Says Skin Cancer Incidence Is Rising

The World Health Organization recommends banning of artificial tanning by minors.

On March 17, 2005, the World Health Organization (WHO) issued a statement on the dangers of artificial tanning and warned that no person under 18 years of age should use tanning beds (see http://www.who.int/mediacentre/news/notes/2005/np07/en/index.html).

Worldwide, one in three cancers is skin-related. By WHO estimates, 132,000 cases of malignant melanoma (66,000 deaths) and more than 2 million cases of other skin cancers occur annually. In the U.S., one in two cancers is skin-related (estimated skin cancers in the U.S. annually, 1.1 million). These figures are on the rise, and the WHO expects the skin-cancer epidemic to accelerate: The annual incidence rate for melanoma is estimated to have more than tripled in the last 45 years in Norway and Sweden and to have doubled in the last 30 years in the U.S. The WHO attributes some of this increase to the growing use of artificial-tanning facilities.

The primary goal of the WHO's current effort is to protect the young. Sunburns in childhood and adolescence have been shown to increase the risk for malignant melanoma later in life. In one study, 26% of tanning bed users in Canada had experienced adverse effects, including burns.¹ Appearance-conscious young people in Australia, New Zealand, North America, and northern Europe are among the multibillion-dollar industry's most avid consumers; 25% of all tanning bed users are in the vulnerable and impressionable 16-24 age group. In recent surveys, 47% of 18- to 19-year-old female Americans² and 57% of Stockholm teenagers used tanning facilities. Many use tanning beds before travel holidays in the erroneous belief that this will protect them from sunburn (actual protection gained approximates SPF 3).³

The WHO encourages governments to formulate and reinforce laws to control the use of tanning operations. At present, however, only a few countries have regulations: Belgium, France, and Sweden limit the maximum proportion of UVB to 1.5% of the UV output (similar to solar radiation). France requires that all UV appliances be registered, prohibits use by minors, mandates that trained personnel supervise all commercial tanning establishments, and forbids them to claim any health benefit. The state of California also prohibits use of tanning salons by minors. Many governmental agencies with responsibility for environmental health and safety inspections are overwhelmed with other duties, leaving an unsupervised tanning industry to give the false impression that sunless tanning is safe.⁴

The WHO's recommendation is part of its overall efforts to protect against overexposure to UV radiation. Short-wavelength UVB (280-315 nm) radiation is a known risk factor for skin cancer, although new research suggests that the contribution of solar exposure is incompletely understood.⁵ Artificial tanning adds to the individual's total UV burden, and there is no evidence that such exposure is less harmful. The longer UVA wavelengths (315-400 nm) that constitute most tanning bed radiation penetrate more deeply into the skin and have been implicated in skin cancer risk.^6,7 Some tanning beds can emit levels of UV radiation many times stronger than the midday summer sun.

In addition to promoting skin cancer, burns, loss of elasticity, wrinkling, and freckling, excess UV exposure can also harm the eyes and may compromise immune function. Some 20 million people worldwide are blinded by cataracts, 20% of which, the WHO estimates, resulted from UV exposure.

Comment: Are there benefits from artificial tanning? Many consumers claim that UV exposure produces a sense of psychological well-being, which might have some physiologic basis, although the mechanism is unknown.⁸ Dietary supplementation is the best way to address deficits in vitamin D synthesis, and phototherapy for skin disorders should always be performed under medical supervision. For seekers of a bronzed appearance, new methods of applying sunless tanning lotions provide a tanned effect without skin mutations.

— James Ferguson, MD, FRCP

Published in Journal Watch Dermatology April 26, 2005

Citation(s):

1. Rhainds M et al. A population-based survey on the use of artificial tanning devices in the Province of Quebec, Canada. J Am Acad Dermatol 1999 Apr; 40:572-6.

• Medline abstract (Free)

2. Demko CA et al. Use of indoor tanning facilities by white adolescents in the United States. Arch Pediatr Adolesc Med 2003 Sep; 157:854-60.

• Original article (Subscription may be required)
• Medline abstract (Free)

3. Faurschou A et al. Sun protection effect of dihydroxyacetone. Arch Dermatol 2004 Jul; 140:886-7.

• Original article (Subscription may be required)
• Medline abstract (Free)

4. Kwon HT et al. Promotion of frequent tanning sessions by indoor tanning facilities: Two studies. J Am Acad Dermatol 2002 May; 46:700-5.

• Medline abstract (Free)

5. Berwick M et al. Sun exposure and mortality from melanoma. J Natl Cancer Inst 2005 Feb 2; 97:195-9.

• Original article (Subscription may be required)
• Medline abstract (Free)

6. Karagas MR et al. Use of tanning devices and risk of basal cell and squamous cell skin cancers. J Natl Cancer Inst 2002 Feb 6; 94:224-6.

• Original article (Subscription may be required)
• Medline abstract (Free)

7. Veierod MB et al. A prospective study of pigmentation, sun exposure, and risk of cutaneous malignant melanoma in women. J Natl Cancer Inst 2003 Oct 15; 95:1530-8.

• Original article (Subscription may be required)
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8. Feldman SR et al. Ultraviolet exposure is a reinforcing stimulus in frequent indoor tanners. J Am Acad Dermatol 2004 Jul; 51:45-51.

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