Into the Light – New Tanning-bed Law Aims to Stem Tide of Skin Cancer

In recent years, many teens have turned to tanning beds to enhance their looks on prom night and graduation day. But that practice is no longer possible, due to a new state law that Gov. Charlie Baker signed in February that bans anyone under the age of 18 from using a tanning bed.
Prior to passage of this measure, Massachusetts allowed teenagers between the ages of 14 and 17 to visit tanning salons with consent from a parent or legal guardian, and those under age 14 to tan if a parent or guardian was present.
However, research by the American Academy of Dermatology, the Melanoma Research Foundation, the American Assoc. for Cancer Research, and other prestigious groups have led to legislation in 42 states prohibiting young people from using tanning beds due to studies that prove exposure to artificial ultraviolet light before the age of 35 increases the risk of melanoma by up to 75{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}.
Melanoma is not only the deadliest form of skin cancer, it is the most common form of cancer in young adults 25 to 29 years old, and the second-most common form in young people 15 to 29 years old. It is also the leading cause of cancer death in women aged 25 to 30 and the second-leading cause of death in women between the ages of 30 and 35. In addition, ultraviolet radiation emitted by tanning beds can lead to basal-cell and squamous-cell cancer and cause wrinkles, lax skin, brown spots, and other signs of premature aging.
Dr. Catherine White, a dermatologist and founder of Hampshire Dermatology and Skin Health Center in Northampton, said dermatologists have been advocating for changes in the law for years, and herald the newly passed legislation, as well as the fact that the U.S. Food and Drug Administration proposed two new rules last year regarding tanning beds. The first would not only restrict use of sunlamps in salons to individuals 18 and older, but also mandate that users sign a certificate before their first tanning session and every six months thereafter acknowledging they have been informed of the risks to their health.
The second proposal would require sunlamp manufacturers and tanning facilities to take additional measures to improve the overall safety of their devices. Suggestions include improving eye safety by limiting the amount of visible light allowed through protective eyewear; improving labeling on replacement bulbs to ensure tanning facility operators are using the correct bulbs, which would reduce the risk of accidental burns; preventing the installation of stronger bulbs without recertifying and re-identifying a device with the FDA; and requiring all sunlamp products to have an emergency shut-off switch that users can easily find and identify by touch or sight.
Artificial tanning has become a $2.5 billion industry, so these measures are deemed critical to people’s safety. Approximately 7.8 million adult women and 1.9 million adult men in the U.S. tan indoors, and reports show that 35{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of American adults, 59{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of college students, and 17{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of teens have used a tanning bed.
White acknowledges that most tanning salons are small businesses that are often owned by women and add vibrancy to local communities, and says it’s important to recognize that fact, but agrees with other experts that medical information regarding tanning beds must be transmitted to clients in a clear way that outlines the risks.
“The World Health Organization has said that ultraviolet light is a known human carcinogen,” she told HCN. “Using a tanning bed is a dangerous activity and increases the risk of developing basal-cell cancer, squamous-cell cancer, and potentially life-threatening melanoma.”

Overcoming Obstacles
Dr. Richard Arenas, chief of Surgical Oncology at Baystate Medical Center, has seen patients in their early 20s with melanoma, and says researchers believe the intensity and type of ultraviolet radiation emitted by tanning beds may be forcing changes at an accumulated rate in cells. Environmental factors may also be at play, and some people may be more sensitive to UV light than others and have family histories that could predispose them to getting skin cancer.
“But the biggest challenge is determining at what age a person is capable of making a decision to acknowledge the potential risk of using a tanning bed,” he explained, adding that there has not been enough publicity about the dangers and the fact that the rate of melanoma is on the rise, especially in young Caucasian women.
White concurs, and says education needs to be ongoing, especially since tanning is part of youth culture; college students often rent limos and go tanning as a group, and she has heard of cheerleading coaches who bring their teams to a tanning salon prior to a meet.
“The light and warmth may feel good, and there may be social benefits, but the fact is, when ultraviolet light hits the skin, it damages genetic material,” she noted. “A tan is an emblem of injury, and is the body’s last-ditch effort to prevent DNA damage and protect against damage to the cells. Sometimes the body can repair the damage, but it’s not always possible.”
Still, most human beings love the sun, and the reasons for visiting tanning salons are complex and include societal reinforcements — people often tell others with a tan they look great — and many women consider going to a tanning salon a way to pamper themselves.
But the dangers that have come to light are clear, and the Commonwealth’s new legislation mirrors similar laws in California, Delaware, the District of Columbia, Hawaii, Illinois, Louisiana, Minnesota, Nevada, New Hampshire, North Carolina, Oregon, Texas, and Vermont that ban the use of tanning beds for all minors under 18.
However, experts say tanning not only is it a difficult habit to break, it can be addictive, which was documented in studies released in 2013 that show ultraviolet light increases the release of endorphins or feel-good chemicals that relieve pain and generate feelings of well-being.
“People like to tan. It’s calming, relaxing, and something that they may regard almost like a treat. And although most adults know it’s not a good thing to do, they have the right to visit a tanning salon. But they need information about the risks spelled out clearly,” White said, adding that dermatologists hope the FDA’s proposal to have adults sign consent forms acknowledging the risks of tanning beds will be adopted nationwide.
As for the addictive nature of the habit, researchers often compare tanning to cigarette smoking. “Both industries can injure customers, and it is to their benefit to start people young before they are able to make informed decisions. And both have an addictive quality which make them difficult to break,” White told HCN.
Misconceptions also exist that range from benefits associated with ultraviolet light and vitamin D — experts say taking supplements is safer — to the fact that some people believe it’s a good idea to get a base tan in the winter before going to a sunny locale such as Florida or the Caribbean.
But that is indeed a myth. “There is nothing protective in going to a tanning salon before a trip, because each exposure increases the risk of developing skin cancer, especially in young people,” White said. “We know that intense ultraviolet exposure is more dangerous early in life than it is later on, and people with a history of childhood sunburns are at greater risk for cancer.”

Prevention is Key
Ultraviolet radiation is made of UVA and UVB wavelengths, or rays. UVA rays cause aging of the skin, while UVB rays are short, more powerful, and can lead to cancer.
The sun delivers both, but Arenas says tanning beds deliver a more significant dose of both UVA and UVB.
“The damage caused at a young age can carry forward for the rest of a person’s life. Tanning beds are an unnatural source of UV radiation and are dangerous,” he noted, adding that the propensity for problems may be exacerbated if people are fair-skinned, sport red hair, or have a lot of moles. In addition, the fact that people are living longer means they will have more exposure to the sun, so putting oneself in harm’s way at a young age is even more dangerous than it may have been generations ago.
Arenas urges people to be their own advocates when it comes to skin cancer, and said everyone should get a full skin checkup each year.
“Insist that your doctor examine your entire body, including the cracks and crevices,” he told HCN, explaining that skin cancer can occur on the palms of the hands and bottoms of the feet, as well as in the genital and anal areas. “You really need to have respect for your skin. We can’t avoid the sun, but people need to appreciate the fact that it causes changes that could lead to skin cancer.”
White says people who love the look of a tan can achieve the same result with spray tans, bronzers, and gradual self-tanners, and since many salons offer spray tans, clients who have purchased tanning packages should ask to have their sessions converted to spray tans. She also advises people using tanning as a means of pampering themselves to think of other ways to reward themselves that they find equally relaxing.
“The bottom line is that skin cancer can be prevented, and the new laws will help,” Arenas said. “All it takes is good judgment.”