Tanning Beds & Skin Cancer: Shedding New Light on a Dangerously Popular Habit

by Rebecca Shatsky, MD 2011 | shatsky@myhousecallmd.com

It’s one of the great paradoxes of life: what we perceive as beautiful has a tendency to be bad for us. Tan skin, while masking cellulite and stretch marks, is quite literally a sign of skin damage. Tanning is a fashion trend. Throughout history, tan skin has fallen in and out of fashion. Unfortunately, for the past forty or fifty years, since the days of fashion icon Coco Chanel, tan skin has been a status symbol that we equate with health, happiness and the lavish life the wealthy can afford filled with luxurious vacations.  Even now in 2010, after the dangers of sun exposure have been spelled out explicitly by dermatologic research, the tanning trend is stronger than ever.  Self-proclaimed “tanorexics” from the MTV series The Jersey Shore (particularly Nicole “Snooki” Polizzi) broadcast their love of tanning beds to anyone who will listen. Last month, Polizzi even slammed president Obama for imposing a new 10% tax on tanning beds that went into effect on July 1st. Republican political opponent, John McCain, was quick to respond to Snooki’s criticism of Obama with a tweet supporting Polizzi’s “freedom to tan,” a fairly controversial move considering McCain’s recent struggle with the deadly skin cancer, malignant melanoma. Naturally, with tanning now in the political hot seat (both literally and figuratively), we at House Call think it’s only appropriate to re-educate our readers on the process of tanning and the dangers of skin caner with scientific research and medical literature leading the debate (instead of reality TV stars and politicians).

The Science of Skin Color:

A person’s natural skin color is determined by the concentration of a pigment called melanin in the skin. Melanin is produced by skin cells called melanocytes. While the number of melanocytes in the skin is fairly similar from person to person, the activity level of these cells when it comes to producing melanin varies greatly and is determined primarily by genetics. The activity of melanocytes is partially responsible for the wide spectrum of skin color that exists among humans.  Also, melanocytes can produce several varieties of melanin, which differ in chemical properties and color. Eumelanin, the most abundant form of the compound, can be either black or brown and is associated with darker skin tones and suntans. Pheomelanin is a yellow-red pigment present in abundance in people with red hair and fair complexions. Some individuals are unable to produce melanin at all due to gene defects or enzyme deficiencies that they are born with. These defects result in very light colored skin, hair and eyes (a condition known as albinism).

Melanin absorbs light and is a natural protectant for skin cells against UV rays that damage DNA.   Pheomelanin absorbs less UV radiation than eumelanin.  Since redheaded people produce more pheomelanin and less eumelanin, red heads do not tan very well and have a much higher incidence of skin cancer (in case you hadn’t noticed). Conversely, darker individuals have continuous production of eumelanin, naturally protecting them from UV DNA damage and lowering their incidence of skin cancer.

What Happens When We Tan?

UV radiation is a carcinogen; it causes mutations in your DNA that your body has to repair before new cells are made in order to prevent cancer from developing. When the skin is exposed to excessive amounts of UV radiation (with frequent sun or tanning bed exposure), the body can’t fix the mutations fast enough and skin cancer can develop. While the production of melanin in the skin is influenced primarily by genetics, it can also be revved up temporarily in response to UV radiation. Exposure to UV light causes an increase in Melanocyte-Stimulating Hormone (MSH), a hormone released from the brain. The release of this hormone into the blood stream revs up production of melanin by melanocytes in the skin, resulting in the golden brown skin color we call a tan. The extra melanin from a suntan is supposed to protect cells from further damage via UV radiation, but the melanin producing pathway takes time (it takes at least four hours to see a tan and then 5-7 days of repeated sun exposure to get the full effect).  In addition, extra melanin does not offer complete protection from DNA damage. Basically, while you spend time building up your base tan you are concurrently building up mutations in your DNA, predisposing yourself to skin cancer.

What’s Wrong With Tanning Beds?

Most people know that sunburns are bad. A sunburn is an immediate indication that the skin has been directly damaged by UV rays and is actively trying to repair that damage by increasing blood flow to the affected area (giving you a painful red hue).  If you are a fair-skinned individual that always burns (even if the burn “turns into a tan”), you are at high risk for skin cancer and every time you get burned you increase that risk.  What we are just learning, however, is that even people who tan easily are at increased risk for skin cancer, especially with repeat long-term exposure from tanning bed use. A landmark study that was published in the June 2010 issue of Cancer Epidemiology Biomarkers and Prevention determined that tanning bed users had a 74% increased risk of developing melanoma. The use of high pressure tanning devices was reported to be particularly dangerous, increasing the risk of melanoma to four times that of people who did not use tanning beds (3). Overall, the amount of exposure is thought to be the greatest risk factor for development of cancer and the cumulative number of tanning hours logged was a significant predictor of cancer development risk. This study is the largest ever to examine the use of indoor tanning as a risk factor for melanoma.  The results have instigated considerable debate amongst the FDA and other preventative health organizations about how to limit the use of tanning beds in the future. The new federal 10% tax on tanning beds instituted on July 1st, 2010 may be the first in a series of steps to reduce the popularity of tanning beds.  There is talk of developing new laws to restrict use among those under the age of 18.


So What Can I Do to Prevent Skin Cancer?

If you are currently frequenting your local tanning salon or laying out and lathering yourself in baby oil, the best thing you can do is stop cold turkey.  Not only is frequent tanning quadrupling your risk of melanoma, it causes premature skin aging (i.e. wrinkles, sagging skin, and brown spots) and cumulative skin damage.  For serious “tanorexics” who still feel they need a golden glow to feel beautiful, the switch to spray tanning can be quite easy and painless.  More and more salons are offering spray tanning as a healthy alternative to UV beds and the array of self-tanning products in drugstores is mind-boggling. The quality of self-tanning products has also significantly improved in recent years.  If you’ve tried self-tanning in the past without success, you may just want to give lotions and sprays another go.  We bet that you will be pleasantly surprised with the results.

Unfortunately, despite the nonsensical banter from politicians and TV personalities, skin cancer remains a formidable enemy in the US, affecting over 2 million people each year (4). Research estimates that one in five Americans will develop skin cancer in their lifetime and, on average, twenty Americans die of skin cancer every day (1,6).  Don’t believe the myth that most skin damage happens during your teens.  Many people in their 20’s and 30’s who tanned in their teens continue to tan because they believe the damage has already been done. According to new data, every time you tan you put yourself at increased risk, no matter how old you are (7).

The Take Home Message:

  • Wear sunscreen when you’re outdoors
  • Leave the tanning beds to the cast of Jersey Shore (hopefully they save some of their new-found income for health care)
  • See your primary care doctor or dermatologist once a year for your annual skin exam as well as your regular skin care.
  • If you’re craving a summer glow, try tanning lotions or spray tans

Skin cancer is the most common form of cancer but it is also highly preventable.  We’ll leave you with a few words of wisdom from The Skin Cancer Foundation: “Tanning’s 15 minutes are over. Go with your own glow!”

Questions? E-mail the Author: shatsky@myhousecallmd.com


References

  1. American Cancer Society. Cancer Facts & Figures 2009. Atlanta: American Cancer Society; 2009.
  2. 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 2003; 46:700-5.
  3. Lazovich, DeAnn, Rachel Vogel, Marianne Berwick, Martin A. Weinstock, Kristin E. Anderson, and Erin M. Warshaw. “Indoor Tanning and Risk of Melanoma: A Case-Control Study in a Highly Exposed Population.” Cancer, Epidemiology, Biomarkers & Prevention 19.6 (2010): 1557-568.
  4. Melanoma of the Skin, Cancer Fact Sheets, National Cancer Institute, SEER Database, 2008
  5. SEER Cancer Statistics Review, 1975-2004 (NCI)
  6. Robinson JK. Sun Exposure, Sun Protection, and Vitamin D. JAMA 2005; 294: 1541-43.
  7. Skin Cancer Facts. The Skin Cancer Foundation. July 15, 2010.
  8. The Burden of Skin Cancer. National Center for Chronic Disease Prevention and Health Promotion. May 13, 2008.

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