28. Why Parents Should Never Allow Teenagers to Tan

Today I heard some bad news. A young person who is important in my life was just diagnosed with a rare and dangerous form of skin cancer on her face. Because of this news, I decided to post a piece on tanning and skin cancer prevention.

Normally I listen to Pandora on my way to work, but recently I’ve been disgusted with the app because they frequently play ads for Palm Beach Tanning (PBT). PBT characterizes tanning as an activity that boosts self-confidence and morale, but indoor tanning is really a way to guarantee skin cancer later in life. In my opinion, indoor tanning should be illegal.

Like smoking, tanning is a known carcinogen and a major public health problem. On a yearly basis in the US, about eight million adult women and two million men tan indoors. The tanning habit often begins during the teenage years and continues into adulthood. About half of indoor tanners initiate the activity before age 21, and 1/3 begin before age 18. Nearly 60% of college students and 20% of teens report using a tanning bed in their lifetimes. Many of these individuals tan with family members, frequently their mothers. In my opinion, taking a teenager to a tanning salon is a lot like offering her a cigarette. From an ethnic standpoint, the people who tan the most are also at the highest risk for developing melanoma. About 70% of tanning patrons are Caucasian females, and melanoma is the second most common cancer in young women aged 15-29 (if basal and squamous cell cancers are included, then skin cancer is the most common malignancy for this demographic).

Why is indoor tanning so harmful? Tanning beds expose skin to UVA and UVB radiation, sometimes at rates 10-15 times higher than the sun. UV radiation causes multiple types of skin cancer, such as melanoma, basal cell cancer, and squamous cell cancer. The increased risk of skin cancer caused by tanning beds isn’t trivial. Just one episode of indoor tanning increases the risk of melanoma by 20%, squamous cell cancer by 20%, and basal cell cancer by 29%. Those who have any history of tanning have an almost 70% risk of developing a basal cell cancer by age 40. Women under age 30 who tan are six times more likely to develop melanoma. Bear in mind that burning while tanning has nothing to do with the risk of developing skin cancer. Rather, the frequency of tanning is what matters. As the number of tanning episodes increases, so does the risk of skin cancer, in a dose-dependent fashion. The risk of developing melanoma, for example, increases 34% after 10 episodes of tanning. Natural sunburns also increase the risk of skin cancer in cumulative fashion and therefore should be avoided.

How much skin cancer do we have in the US? Too much! Each year in this country, more than three million people develop skin cancer. Over the past three decades, more people have had skin cancer than all other cancers combined. Nearly one out of two Americans who live to age 65 will develop either basal or squamous cell cancer once in their lives. My fair-skinned Irish husband had his first basal cell cancer removed several years ago, and his parents have needed invasive surgery on more than one occasion to remove theirs. While basal cell cancer doesn’t sound like a big deal, a nickel-sized hole in your nose or along your lip line is indeed a major problem. Of the three main types of skin cancer, melanoma is the least common at 87,000 cases per year, but also the most serious. Every hour one person in the US dies from melanoma. Not only does tanning cause melanoma in the skin, but it can also cause ocular melanoma. Recently I read an unfortunate story about a young mother who lost an eye to ocular melanoma just before delivering healthy twins. I couldn’t help wondering whether she had tanned as a teenager.

Due to the risks of indoor tanning, tanning beds are considered “moderate-risk devices.” Numerous states plus the District of Columbia prohibit people younger than 18 from using indoor tanning devices (these include California, Delaware, Hawaii, Illinois, Kansas, Louisiana, Massachusetts, Minnesota, Nevada, New Hampshire, North Carolina, Oklahoma, Texas, Vermont and West Virginia). Oregon and Washington prohibit those under 18 from using indoor tanning devices, unless a prescription is provided. Minors under 18 can’t tan in three counties in Maryland: Prince George’s County, Montgomery County and Howard County. In Connecticut, New Jersey, New York and Pennsylvania tanning is banned under age 17. Minors under16 are prohibited from tanning in Indiana and Wisconsin, while children under the age of 14 aren’t allowed to tan in Alabama, Georgia, Idaho, Maine and North Dakota. Indoor tanning is 100% banned in Brazil, where skin cancer is the most common malignancy, and in Australia (no guns, no tanning salons—those Australians are doing great when it comes to positive public health measures!).

Over the years in my office, I have encountered several adolescent girls who became addicted to indoor tanning. Interestingly, indoor tanning is associated with an increased risk of substance abuse and eating disorders, and studies have shown that more than 1/5 of Caucasian women age 18-30 have signs of tanning addiction. Although these young women usually understand the health risks of tanning, physical and psychological dependence prevent them from quitting the habit. I will never forget one of my fair-skinned, freckle-faced patients who developed a habit of tanning twice monthly, all winter long! At some point in her life, if she lives long enough, she is undoubtedly going to need treatment for skin cancer.

Along with skin cancer, tanning causes premature skin aging and wrinkles. Sometimes discussing the risk of premature aging has more impact on a teen’s tanning behavior than talking about cancer, and I would urge parents to mention this if necessary. Because regular use of SPF 15 or higher sunscreen markedly decreases the risk of developing skin cancer, every family’s bathroom cabinet should contain sunscreen. For young children, parents should apply sunscreen daily (especially during the summer months), and teenagers should be encouraged to self-apply sunscreen as much as possible. Every summer, pediatricians unfortunately treat a multitude of blistering sunburns, usually the day after a trip to the beach. Teens frequently spend hours with their friends in the sun, and parents may not to be present to remind them to apply sunscreen. The results can be horrible. For trips to the beach, wearing protective clothing (hats, sunglasses, lightweight long-sleeve shirts, or T-shirts at a minimum) and using a tent or wide umbrella are critical to preventing severe sunburns.

Below is a summary of steps that can be taken to decrease the risk of skin cancer:

-Don’t allow teens to tan indoors, ever. Just one episode of tanning markedly increases the risk of developing skin cancer later in life.

-Regularly use sunscreen, SPF 15 or higher.

-Stay out of the sun during peak hours, 10 am – 4 pm.

-If sun exposure can’t be avoided, wear protective clothing.

-When going to the beach, bring a tent or umbrella, and seek out areas of shade if possible.

-Remind teens that tanning causes premature wrinkling and skin aging.