Who Tans Indoors?

• On an average day in the United States, more than 1 million people tan in tanning salons.1

• Nearly 70 percent of tanning salon patrons are Caucasian girls and women, primarily aged 16 to 29 years.2

• Nearly 28 million people tan indoors in the United States annually. Of these, 2.3 million are teens.3,4
• The indoor tanning industry has an estimated revenue of $5 billion, a fivefold increase from 1992.4,5

Risks of Indoor Tanning

• The United States Department of Health and Human Services and the International Agency of Research on Cancer panel has declared ultraviolet (UV) radiation from the sun and artificial sources, such as tanning beds and sun lamps, as a known carcinogens (cancer-causing substances).6
• Indoor tanning equipment, which includes all artificial light sources, including beds, lamps, bulbs, booths, etc., emits UVA and UVB radiation. The amount of the radiation produced during indoor tanning is similar to the sun, and in some cases might be stronger.7,8
• A Swedish study presents strong evidence that exposure to UV radiation during indoor tanning increases the risk of melanoma, especially when a user is exposed at an early age.9
• Evidence from several studies has shown that exposure to UV radiation from indoor tanning devices is associated with an increased risk of melanoma and non-melanoma skin cancer, such as squamous cell carcinoma and basal cell carcinoma.1,2,9-11
• A review of seven studies found a 75 percent increase in the risk of melanoma in those who had been exposed to UV radiation from indoor tanning before the age of 35.11
• Studies have demonstrated that exposure to UV radiation during indoor tanning damages the DNA in the skin cells. Excessive exposure to UV radiation during indoor tanning can lead to premature skin aging, immune suppression, and eye damage, including cataracts and ocular melanoma. 1,12-15
• Indoor tanning beds/lamps should be avoided and should not be used to obtain vitamin D because UV radiation from indoor tanning is a risk factor for skin cancer. Vitamin D can be obtained by a eating a healthy diet and by taking oral supplements.
• In a recent survey of adolescent tanning bed users, it was found that about 58 percent had burns due to frequent exposure to indoor tanning beds/lamps.16
• The FDA estimates that there are about 3,000 hospital emergency room cases a year due to indoor tanning bed and lamp exposure.17

Legislation

• In the United States, only 31 states regulate indoor tanning use by minors, despite the call from the World Health Organization (WHO) to prohibit minors from indoor tanning because of the danger of skin cancer.
• The FDA is considering modification of the labeling of indoor tanning beds based upon the results of focus groups held in concordance with the TAN Act (FDA reform bill HR 3580). The FDA's report to Congress, which included the results of these focus groups, indicated that a different wording and format of the tanning bed label was more easily understood by focus group participants.

Academy Position Statement on Indoor Tanning

• The American Academy of Dermatology Association (AADA) opposes indoor tanning and supports a ban on the production and sale of indoor tanning equipment for non-medical purposes.
• The American Academy of Dermatology supports the WHO recommendation that minors should not use indoor tanning equipment because indoor tanning devices emit UVA and UVB radiation, and because overexposure to UV radiation can lead to the development of skin cancer.
• Unless and until the FDA bans the sale and use of indoor tanning equipment for non-medical purposes, the Academy supports restrictions for indoor tanning facilities, including:
• No person or facility should advertise the use of any UVA or UVB tanning device using wording such as “safe,” “safe tanning,” “no harmful rays,” “no adverse effect,” or similar wording or concepts.

1 Whitmore SE, Morison, WL, Potten CS, Chadwick C. Tanning salon exposure and molecular alterations. J Am Acad Dermatol 2001;44:775-80.
2 Swerdlow AJ, Weinstock MA. Do tanning lamps cause melanoma? An epidemiologic assessment. J Am Acad Dermatol 1998;38:89-98.
3 Kwon HT, Mayer JA, Walker KK, Yu H, Lewis EC, Belch GE. Promotion of frequent tanning sessions by indoor tanning facilities: two studies. J Am Acad Dermatol 2002;46:700-5.
4 Dellavalle RP, Parker ER, Ceronsky N, Hester EJ, Hemme B, Burkhardt DL, et al. Youth access laws: in the dark at the tanning parlor? Arch Dermatol 2003;139:443-8.
5 Demierre MF. Time for the national legislation of indoor tanning to protect minors. Arch Dermatol 2003;139:520-4.
6 U.S. Department of Health and Human Services, Public Health Service, National Toxicology Program. Report on carcinogens, 11th ed: Exposure to sunlamps or sunbeds.
7 Hornung RL, Magee KH, Lee WJ, Hansen LA, Hsieh YC. Tanning facility use: are we exceeding the Food and Drug Administration limits? J AM Acad Dermatol. 2003 Oct;49(4):655-61.
8 Miller, SA, Hamilton, SL, Wester, UG, Cyr, WH. An analysis of UVA emissions from sunlamps and the potential importance for melanoma. Photochem Photobiol 68(1998), 63-70.
9 Westerdahl J, Ingvar C, Masback A. Jonsson N, Olsson H. Risk of cutaneous malignant melanoma in relation to use of sunbeds: further evidence for UV-A carcinogenicity. Br J Cancer 2000;82:1593-9.
10 Karagas M, et al. "Use of tanning devices and risk of basal cell and squamous cell skin cancers.” Journal of the National Cancer Institute. 2002 February 6;94(3):224-6.
11 The International Agency for Research on Cancer Working Group on artificial ultraviolet (UV) light and skin cancer "The association of use of sunbeds with cutaneous malignant melanoma and other skin cancers: A systematic review.” International Journal of Cancer. 2007 March 1;120:111-1122.
12 Piepkorn M. Melanoma genetics: an update with focus on the CDKN2A(p16)/ARF tumor suppressors. J Am Acad Dermatol. 2000 May;42(5 Pt 1):705-22; quiz 723-6.
13 Vajdic CM, Kricker A, Giblin M, McKenzie J, Aitken JF, Giles GG, Armstrong BK. Artificial ultraviolet radiation and ocular melanoma in Australia. Int J Cancer. 2004 Dec 10;112(5):896-900.
14 Walters BL, Kelly TM. Commercial tanning facilities:a new source of eye injury. Am J Emerg Med 1987;120:767-77.
15 Clingen PH, Berneburg M, Petit-Frere C, Woollons A, Lowe JE, Arlett CF, Green MH. Contrasting effects of an ultraviolet B and an ultraviolet A tanning lamp on interleukin-6, tumour necrosis factor-alpha and intercellular adhesion molecule-1 expression. Br J Dermatol. 2001 Jul;145(1):54-62.
16 Cokkinides V, Weinstock M, Lazovich D, Ward E, Thun M. Indoor tanning use among adolescents in the US, 1998-2004. Cancer 2009; 115: 190-198.
17The FDA - accessed September 2009. http://www.fda.gov/Radiation-EmittingProducts/RadiationEmittingProductsandProcedures/HomeBusinessandEntertainment/ucm116447.htm