Indoor tanning

Indoor tanning use 

  • Thirty-five percent of American adults, 59 percent of college students, and 17 percent of teens have reported using a tanning bed in their lifetime.1
  • Approximately 7.8 million adult women and 1.9 million adult men in the United States tan indoors.2
  • Research indicates that more than half of indoor tanners (52.5 percent) start tanning before age 21, while nearly one-third (32.7 percent) start tanning before age 18.3
      • 44.5 percent of those who started tanning before age 16 reported that they did so with a family member.3
      • 49.2 percent of those who started tanning with a family member did so with their mother.3
  • 10.6 percent of all female high school students have tanned indoors, and 15.2 percent of Caucasian female high school students have tanned indoors.4
  • Nearly 70 percent of tanning salon patrons are Caucasian girls and young women, and melanoma is the second most common cancer in females age 15-29.5-6
  • The indoor tanning industry’s revenue was estimated to be $2.6 billion in 2010.7

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).8    
    • 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.9
  • 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 that of the sun, and in some cases might be stronger.10-11
  • Evidence from multiple studies has shown that exposure to UV radiation from indoor tanning devices is associated with an increased risk of melanoma and nonmelanoma skin cancer, including squamous cell carcinoma and basal cell carcinoma.12-18   
    • Researchers estimate that indoor tanning may cause upwards of 400,000 cases of skin cancer in the U.S. each year.1, 15
    • Higher melanoma rates among young females compared to young males may be due in part to widespread use of indoor tanning among females.19
  • Using indoor tanning beds before age 35 can increase your risk of melanoma, the deadliest form of skin cancer, by 59 percent; the risk increases with each use.12, 18, 20-21    
    • Women younger than 30 are six times more likely to develop melanoma if they tan indoors.22
    • 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.23
  • Even one indoor tanning session can increase users’ risk of developing squamous cell carcinoma by 67 percent and basal cell carcinoma by 29 percent.15         
    • Indoor tanning before age 24 increases one’s risk of developing basal cell carcinoma by age 50.24
  • The estimated cost of treating 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.25
  • 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. 17, 26-29         
    • A recent investigation estimated that 3,234 injuries related to indoor tanning — including burns, loss of consciousness and eye injuries — were treated in U.S. hospital emergency departments every year from 2003 to 2012.30
  • In addition to the above-mentioned risks, frequent, intentional exposure to UV light may lead to tanning addiction.31-32
  • 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

  • In May 2014, the U.S. Food and Drug Administration issued new regulations strengthening warnings for indoor tanning devices. These regulations include:
    • A strong recommendation against the use of tanning beds by minors under 18.
    • The reclassification of tanning beds and sunlamps from Class I to a 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.
  • In December 2015, the FDA proposed an age restriction on indoor tanning for minors under the age of 18, as well as a risk acknowledgement form that all adults must sign before using indoor tanning devices.
    • While this proposal was ultimately not finalized, the American Academy of Dermatology Association continues to support state and national efforts that place restrictions on indoor tanning for minors, including restrictions on indoor tanning for minors 18 and under.   
  • California, Delaware, the District of Columbia, Hawaii, Illinois, Kansas, Louisiana, Massachusetts, Minnesota, Nevada, New Hampshire, North Carolina, Texas and Vermont 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 years old from using indoor tanning devices, unless a prescription is provided.
  • Connecticut, New Jersey, New York 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 14 are prohibited from using tanning devices in Alabama, Georgia, Idaho, Maine, North Dakota and West Virginia.

Read the Academy position statement on 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. 

Learn more about the dangers of indoor tanning:

 

1Wehner MR, Chren M, Nameth D, et al. International Prevalence of Indoor Tanning: A Systematic Review and Meta-analysis.JAMA Dermatol. 2014;150 (4): 390-400. doi:10.1001/jamadermatol.2013.6896.

2 Guy GP, Berkowitz Z, Holman D and Hartman A. Recent Changes in the Prevalence and Factors Associated With Frequency of Indoor Tanning Among U.S. Adults. JAMA Dermatol 2015; Published online July 1, 2015.

3Watson M, Shoemaker M, Baker K. Indoor Tanning Initiation Among Tanners in the United States. JAMA Dermatol. Published online March 22, 2017. doi:10.1001/jamadermatol.2016.5898

4Kann L, McManus T, Harris WA, et al. Youth Risk Behavior Surveillance — United States, 2015. MMWR Surveill Summ 2016;65(No. SS-6):1–174. DOI: http://dx.doi.org/10.15585/mmwr.ss6506a1

5Choi, K., Lazovich, D., Southwell, B., Forster, J., Rolnick, S. J., and Jackson, J. Prevalence and characteristics of indoor tanning use among men and women in the United States. Archives of Dermatology, Vol. 146 2010, No. 12, pp. 1356-61.

6NAACCR Fast Stats: An interactive tool for quick access to key NAACCR cancer statistics. North American Association of Central Cancer Registries. http://www.naaccr.org/. (Accessed on 3-10-2016)

7“Tanning Salons in the US: 81219c.” IBIS World Industry Report. 2009 August 7.

8U.S. Department of Health and Human Services, Public Health Service, National Toxicology Program. Report on carcinogens, 14th ed: Ultraviolet-radiation-related exposures. 2016. http://ntp.niehs.nih.gov/go/roc14/

9Shain, AH et al. The genetic evolution of melanoma from precursor lesions. N Engl J Med 2015; 373:1926-1936.

10Hornung 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.

11Miller, 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.

12The 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.

13Karagas 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.

14Colantonio 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.

15Wehner MR, Shive ML, Chren MM, Han J, Qureshi AA, Linos E. Indoor tanning and non-melanoma skin cancer: systematic review and meta-analysis. BMJ. 2012 Oct 2;345:e5909.

16Whitmore SE, Morison, WL, Potten CS, Chadwick C. Tanning salon exposure and molecular alterations. J Am Acad Dermatol 2001;44:775-80.   

17Lim HW, James WD, Rigel DS, Maloney ME, Spencer JM, Bhushan R. Adverse effects of ultraviolet radiation from the use of indoor tanning equipment: time to ban the tan. J Am Acad Dermatol. 2011 May;64(5):893-902.

18Boniol M, Autier P, Boyle P, Gandini S. Cutaneous melanoma attributable to sunbed use: systematic review and meta-analysis. BMJ. 2012 Jul 24;345:e4757.                       

19Guy 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.

20Lazovich, D, et al. "Indoor Tanning and Risk of Melanoma: A Case-Control Study in a Highly Exposed Population." Cancer Epidemiol Biomarkers Prev. 2010 June;19(6):1557-1568.

21Corrections: Cutaneous melanoma attributable to sunbed use: systematic review and meta-analysis. British Medical Journal 2012;345:e8503.

22Lazovich D, et al. Association Between Indoor Tanning and Melanoma in Younger Men and Women. JAMA Dermtol. 2016; 152(3):268-275. doi:10.1001/jamadermatol.2015.2938.

23Vogel 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.

24 Karagas MR, et al. Early-onset basal cell carcinoma and indoor tanning: a population-based study. Pediatrics. 2014 Jul;134(1):e4-12. doi: 10.1542/peds.2013-3559.

25 Waters HR and Adamson A. The health and economic implications of using tanning devices. J Cancer Policy. 2016. http://dx.doi.org/10.1016/j.jcpo.2016.12.003.

26Piepkorn 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.

27Vajdic 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.

28Walters BL, Kelly TM. Commercial tanning facilities:a new source of eye injury. Am J Emerg Med 1987;120:767-77.

29Clingen 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.

30Guy G, Watson M, Haileyesus T, Annest J. Indoor tanning-related injuries in a national sample of US hospital emergency departments. JAMA Intern Med. Published online December 15, 2014.

31Fisher DE , James WD. Indoor tanning--science, behavior, and policy. N Engl J Med 2010;363:901-3. 

32Lim HW, James WD, Rigel DS, Maloney ME, Spencer JM, Bhushan R. Adverse effects of ultraviolet radiation from the use of indoor tanning equipment: Time to ban the tan. J Am Acad Dermatol 2011;64:e51-60.