Indoor tanning
Indoor tanning use
The global prevalence of indoor tanning in adolescents for 2013-2018 was 6.5%, and 10.4% in adults.1
Though the numbers have been decreasing in recent years, approximately 7.8 million adults in the U.S. still engage in indoor tanning.2
Among high school students in the U.S., tanning has declined in recent years, but has not stopped entirely.3
In 2019, 8.4% of white female high school students have tanned indoors.4
Since 2007, adult indoor tanning prevalence has significantly decreased in states that have enacted youth access legislation but has not significantly decreased over time in states with no age restrictions on indoor tanning use.5
Though indoor tanning in U.S. adults has declined in recent years, according to 2018 data, about a quarter of those who report any indoor tanning, tanned 25 times or more in one year.5
Risks of indoor tanning
The United States Department of Health and Human Services and the World Health Organization's International Agency of Research on Cancer panel have declared ultraviolet radiation from the sun and artificial sources, such as tanning beds and sun lamps, to be a known carcinogen (cancer-causing substance).6,7
Research indicates that UV light from the sun and tanning beds can both cause melanoma and increase the risk of a benign mole progressing to melanoma.8
Indoor tanning equipment, which includes all artificial light sources, including beds, lamps, bulbs, booths, etc., emits harmful UVA and UVB radiation. The amount of the radiation produced during indoor tanning is similar to that of the sun, and in some cases might be stronger.9-10
Evidence from multiple studies has shown that exposure to UV radiation from indoor tanning devices is associated with an increased risk of melanoma, the deadliest form of skin cancer, and nonmelanoma skin cancer, including squamous cell carcinoma and basal cell carcinoma.11-13
Indoor tanning can increase users’ risk of developing squamous cell carcinoma by 58% and basal cell carcinoma by 24%.11
Higher melanoma rates among young females compared to young males may be due in part to widespread use of indoor tanning among females.14
Sexual minority males have a higher lifetime risk of both indoor tanning and of skin cancer compared with heterosexual men.15
Using tanning beds before age 20 can increase your chances of developing melanoma by 47%, and the risk increases with each use.11
Women younger than 30 are six times more likely to develop melanoma if they tan indoors.16
Over three quarters of high school in the United States who use engaged in indoor tanning had experienced at least 1 sunburn.17
Adolescents who engage in indoor tanning before the age of 18 are more likely to continue indoor tanning as adults.18
High school students with poor mental health or who engaging in risky health behaviors may be more prone to indoor tanning.19
Research demonstrates that even people who do not burn after indoor tanning or sun exposure are at an increased risk of melanoma if they tan indoors.20
Indoor tanning is also associated with increased risk for being diagnosed with melanoma more than once.21
The estimated cost of treating the skin cancers attributable to indoor tanning is $343.1 million a year, leading to a total economic loss of $127.3 billion over the lifetime of those affected.22
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.23-27
In addition to the above-mentioned risks, frequent, intentional exposure to UV light may lead to tanning addiction.28-29
Research indicates that more than one-fifth of white women age 18-30 years old who tan indoors exhibit indoor tanning dependence.29
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 eating a healthy diet and by taking oral supplements.
Legislation and regulations
U.S. Food and Drug Administration regulations on indoor tanning include:
A strong recommendation against the use of tanning beds by minors under 18.
Classification of tanning beds and sunlamps from Class I to Class II medical devices, which means they are considered “moderate to high risk.” The FDA mandates additional oversight of Class II devices, requiring manufacturers to provide more safety assurances.
Labeling that:
Clearly informs users about the risks of using tanning beds.
Warns frequent users of sunlamps to be regularly screened for skin cancer.
Alerts users that tanning lamps are not recommended for people under 18 years old.
The American Academy of Dermatology Association supports state and national efforts that place restrictions on indoor tanning for minors, including restrictions on indoor tanning for minors 18 and under.
California, Delaware, District of Columbia, Hawaii, Illinois, Kansas, Louisiana, Maine, Maryland, Massachusetts, Minnesota, Nevada, New Hampshire, New York, North Carolina, Oklahoma, Oregon, Rhode Island, Texas, Vermont, Virginia, Washington, and West Virginia have passed laws that prohibit minors under the age of 18 from indoor tanning.
Oregon and Washington have passed laws prohibiting minors under the age of 18 from using indoor tanning devices, unless a prescription is provided.
Connecticut, New Jersey, and Pennsylvania have passed legislation banning minors under the age of 17 from using tanning devices.
Minors under the age of 16 are prohibited from using tanning devices in Indiana and Wisconsin, while minors under the age of 15 are prohibited from using tanning devices in Alabama, and those under 14 are prohibited from using tanning devices in Georgia, Idaho, and North Dakota.
Academy position statement about indoor tanning
The AADA opposes indoor tanning and supports a ban on the production and sale of indoor tanning equipment for nonmedical purposes.
The AADA 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 nonmedical 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.
Related AAD resources
Last updated: 6/21/22
1Rodriguez-Acevedo AJ, Green AC, Sinclair C, van Deventer E, Gordon LG. Indoor tanning prevalence after the International Agency for Research on Cancer statement on carcinogenicity of artificial tanning devices: systematic review and meta-analysis. Br J Dermatol. 2020;182(4):849-859. doi:10.1111/bjd.18412.
2Guy GP Jr, Watson M, Seidenberg AB, Hartman AM, Holman DM, Perna F. Trends in indoor tanning and its association with sunburn among US adults. J Am Acad Dermatol. 2017;76(6):1191-1193. doi:10.1016/j.jaad.2017.01.022.
3Holman DM, Jones SE, Qin J, Richardson LC. Prevalence of Indoor Tanning Among U.S. High School Students from 2009 to 2017. J Community Health. 2019;44(6):1086-1089. doi:10.1007/s10900-019-00685-y.
4Centers for Disease Control and Prevention (CDC). 1991-2019 High School Youth Risk Behavior Survey Data. Available at http://yrbs-explorer.services.cdc.gov/. Accessed February 12, 2021.
5National Cancer Institute. HINTS Brief Number 44: Indoor Tanning Trends Among US Adults (cancer.gov).
6IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, No. 100D. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Lyon (FR): International Agency for Research on Cancer; 2012.
7NTP (National Toxicology Program). 2021. Report on Carcinogens, Fifteenth Edition.; Research Triangle Park, NC: U.S. Department of Health and Human Services, Public Health Service. https://ntp.niehs.nih.gov/go/roc15. DOI: https://doi.org/10.22427/NTP-OTHER-1003.
8Shain, AH et al. The genetic evolution of melanoma from precursor lesions. N Engl J Med 2015; 373:1926-1936.
9Hornung 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.
10Reza Ghiasvand, Corina S. Rueegg, Elisabete Weiderpass, Adele C. Green, Eiliv Lund, Marit B. Veierød, Ghiasvand et al. Respond to “Indoor Tanning—A Melanoma Accelerator?”, American Journal of Epidemiology, Volume 185, Issue 3, 1 February 2017, Pages 160–161.
11An S, Kim K, Moon S, et al. Indoor Tanning and the Risk of Overall and Early-Onset Melanoma and Non-Melanoma Skin Cancer: Systematic Review and Meta-Analysis. Cancers (Basel). 2021;13(23):5940. Published 2021 Nov 25. doi:10.3390/cancers13235940
12O'Sullivan DE, Brenner DR, Demers PA, et al. Indoor tanning and skin cancer in Canada: A meta-analysis and attributable burden estimation. Cancer Epidemiol. 2019;59:1-7. doi:10.1016/j.canep.2019.01.004
13Colantonio S, Bracken MB, Beecker J. The association of indoor tanning and melanoma in adults: systematic review and meta-analysis. J Am Acad Dermatol 2014;70:847–57.
14Guy GP Jr, Thomas CC, Thompson T, Watson M, Massetti GM, Richardson LC. Vital signs: melanoma incidence and mortality trends and projections - United States,1982-2030. MMWR Morb Mortal Wkly Rep. 2015 Jun 5;64(21):591-6.
15Singer S, Tkachenko E, Yeung H, Mostaghimi A. Skin cancer and skin cancer risk behaviors among sexual and gender minority populations: A systematic review. J Am Acad Dermatol. 2020;83(2):511-522. doi:10.1016/j.jaad.2020.02.013
16Lazovich D, Isaksson Vogel R, Weinstock MA, Nelson HH, Ahmed RL, Berwick M. Association Between Indoor Tanning and Melanoma in Younger Men and Women. JAMA Dermatol. 2016;152(3):268-275. doi:10.1001/jamadermatol.2015.2938
17Guy GP Jr, Berkowitz Z, Everett Jones S, Watson M, Richardson LC. Prevalence of Indoor Tanning and Association With Sunburn Among Youth in the United States. JAMA Dermatol. 2017;153(5):387-390. doi:10.1001/jamadermatol.2016.6273
18Solazzo AL, Geller AC, Hay JL, et al. Indoor Ultraviolet Tanning Among U.S. Adolescents and Young Adults: Results From a Prospective Study of Early Onset and Persistence. J Adolesc Health. 2020;67(4):609-611. doi:10.1016/j.jadohealth.2020.03.027
19Wei G, Turner K. Indoor tanning linked to mental health and risk behaviour among US high school students. J Paediatr Child Health. 2021;57(5):752-754. doi:10.1111/jpc.15456
20Vogel RI, Ahmed RL, Nelson HH, Berwick M, Weinstock MA, Lazovich D. Exposure to indoor tanning without burning and melanoma risk by sunburn history. J Natl Cancer Inst. 2014 Jul 16;106(7). pii: dju219. doi: 10.1093/jnci/dju219.
21Karapetyan L, Yang X, Wang H, et al. Indoor tanning exposure in association with multiple primary melanoma. Cancer. 2021;127(4):560-568. doi:10.1002/cncr.33307
22Waters HR and Adamson A. The health and economic implications of using tanning devices. J Cancer Policy 2018;17:45-50. https://doi.org/10.1016/j.jcpo.2016.12.003
23World Health Organization. Artificial tanning devices: public health interventions to manage sunbeds. World Health Organization, 2017.
24Piepkorn 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.
25Vajdic 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.
26Walters BL, Kelly TM. Commercial tanning facilities:a new source of eye injury. Am J Emerg Med 1987;120:767-77.
27Clingen 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.
28Nguyen NT, Fisher DE. MITF and UV responses in skin: From pigmentation to addiction [published correction appears in Pigment Cell Melanoma Res. 2020 Mar;33(2):383]. Pigment Cell Melanoma Res. 2019;32(2):224-236. doi:10.1111/pcmr.12726
29Mays D, Atkins MB, Ahn J and Tercyak KP. Indoor tanning dependence in young adult women. Cancer, Epidemiology, Biomarkers and Prevention. Published online Oct. 19, 2017.
