Indoor Tanning and Melanoma: A Direct Link

Darrell S. Rigel, MD

Clinical Professor, New York University Medical School

Past President – American Society for Dermatologic Surgery

American Society for Dermatologic Surgery

• 5200 members who diagnose and treat skin cancers

•Members performed over 3.1 million skin cancers procedures last year, a 55% increase over 2005 *

•Regularly see people who have been exposed to tanning beds develop skin cancer

*ASDS Survey – Perceptions Solutions 2009

UV is a carcinogen

• UVB – “complete” carcinogen– Energy is directly absorbed by DNA

– Pyrimidine dimer formation

• UVA – “indirect” carcinogen– Excites chromophores and generates free radicals DNA strand

breaks

• UV listed as known carcinogen by FDA

• WHO classified UV tanning beds as “carcinogenic to humans”

Matsumura et al, Toxicol Applied Pharmcol, 2004http://ntp.niehs.nih.gov/ntp/roc/eleventh/profiles/s183uvrr.pdf, 2005Lancet Oncology, Aug 2009.

Is increased melanoma risk associated with tanning bed usage?

Sunburns, Tanning Bed Usage and MM

• 413 MM patients vs. 416 controls

• Risk factors for the development of MM were 10 or more

sunburns and tanning bed use in fair skinned young

subjects

• Conclusion:

– Melanoma risk increased in tanning bed users

– Risk may be underestimated due to only mean lag time

in study of 7 years from tanning bed exposure to MM

Bataille et al, Eur J Cancer, 2004

Risk Factors for MM in WomenTanning Beds, Sun Exposure, Pigmentation

• 106,379 Scandinavian women with 8 years of FU• 187 MM diagnosed during study interval• Factors that significantly influenced MM risk:

– larger body surface area – number of nevi on legs– red hair– sunburns per year– use of tanning beds >= once a month

• Conclusion:– Tanning bed use influences Melanoma risk– Full effects of exposure may not yet be seen

Veierod et al, JNCI, 2003

Tanning and Melanoma Risk

• Significantly increased risk of developing MM (OR=1.8) for persons exposed to UV tanning beds even after accounting for other risk factors by multivariate analysis

• Conclusion:– Significant association with tanning and the

later development of Melanoma

Westerdahl et al, Br J Cancer, 2000

Tanning Salons and MM Risk

• 200 MM pts with 804 controls from the Nurse Health Study

• RR = 2.1 for ever vs. never tanning salon usage

• Conclusion:– Tanning bed use associated with Melanoma

Han et al, Int J Epidemiol, 2006

Tanning beds and Melanoma Risk

• 10 studies comparing “ever” vs. “never” exposed to UV tanning beds

• MM risk OR=1.25 ever using a tanning bed

• Conclusion:– Significant association with “ever” tanning in UV

tanning beds and the later development of Melanoma

Gallagher et al, Cancer Epidemiol Biomarkers Prev, 2005

Tanning and Melanoma Risk

• 1518 dermatology pts surveyed for skin cancer history and tanning bed usage

• MM risk OR 1.64 ever using a tanning bed

• OR=3.2 for women <45 (OR=4.2 if tanning sessions >20 mins)

• Conclusion:– Significant association with tanning and the

later development of Melanoma (especially in younger women)

Ting et al, Int J Dermatol, 2007

Tanning and Melanoma Risk

• 423 cases of MM vs. 678 controls for tanning and sunlamp usage

• MM risk OR 1.39 ever using a sunlamp and 1.14 ever using a tanning bed

• Latency may not yet be long enough to see full effect of risk for developing MM

• Conclusion:– Significant association with tanning and the

later development of Melanoma

Clough-Corr et al, Cancer Causes Control, 2008

Tanning Bed use and MM risk• Meta-analysis of 19 studies• RR 1.15 for MM with tanning bed use• RR 1.75 if tanning began prior to age 35• Evidence does not support a protective effect of

the use of tanning beds against damage to the skin from subsequent sun exposure

• Conclusion:– Young adults should be discouraged from using

indoor tanning equipment and restricted access to tanning beds by minors should be strongly considered

Green et al, Int J Cancer, 2007

Tanning Beds and MM RiskRisk of Multiple vs. Single Primary MM

• 531 MM patients (125 Multiple/406 single)• 152 reported prior tanning bed usage• Results

– Adjusted for natural UV (sun) exposure history– OR = 1.68 for Tanning Bed usage– First exposure before age 20 (OR = 2.6)

• Conclusion:– Significant association of Melanoma risk and UV-

emitting tanning beds

Chiu et al, World Congress on Melanoma, 2005

Dermatologists are seeing: More melanomas in young women…

in anatomic sites where the “sun doesn’t shine”

Something that was very rarely seen a decade ago

Virtually every one of these young women with melanoma that I see have a significant indoor tanning history!

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• Ban the use and sale of tanning devices in the US

If this cannot be done:

• Reclassify tanning devices to the strongest possible

category• Restrict access to tanning beds by minors• Require posted warning statements• Require informed consent for all consumers• Implement and enforce labeling recommendations

from the TAN Act• Enforce additional state regulations

The ASDS Requests the FDA to: