Consumer Health Information www.fda.gov/consumer Indoor Tanning: The Risks of Ultraviolet Rays

unlamps and tanning beds promise consumers a Melanoma: One Woman’s Story Sbronzed body year-round, Brittany Lietz Cicala of Chesapeake but the ultraviolet (UV) radia- Beach, Md., began tanning indoors at tion from these devices poses age 17. She stopped at age 20 when serious health risks. she was diagnosed with melanoma, the deadliest form of skin cancer. “Although some people think that a The former Miss Maryland says she tan gives them a ‘healthy’ glow, any tan is a sign of skin damage,” says used tanning beds at least four times Sharon Miller, M.S.E.E., a Food and a week, and sometimes every day. Drug Administration (FDA) scientist “Growing up, until I started using tan- and international expert on UV radia- ning beds, my parents were very strict tion and tanning. about me wearing sunscreen,” says “A tan is the skin’s reaction to expo- Cicala. Although she also tanned in sure to UV rays,” says Miller. “Rec- the summer sun during her 3 years of ognizing exposure to the rays as an tanning bed use, Cicala estimates that ‘insult,’ the skin acts in self-defense by producing more melanin, a pig- 90 percent of her UV exposure was in ment that darkens the skin. Over tanning beds during this period. time, this damage will lead to prema- turely aged skin and, in some cases, In the 4 years since she was diag- skin cancer.” nosed, Cicala’s surgeries have left Two types of UV radiation that pen- her with about 25 scars. Cicala gets etrate the skin are UV-B and UV-A a head-to-toe exam for skin cancer rays. every 3 months, which usually results • UV-B rays penetrate the top layers in removal of a suspicious growth. of skin and are most responsible for sunburns. • UV-A rays penetrate to the deeper layers of the skin and are often associated with allergic reactions, such as a rash.

Both UV-B and UV-A rays damage the skin and can lead to skin cancer. Tanning salons use lamps that emit both UV-A and UV-B radiation.

Photos by Nancy Lietz Cancer Risk This 7-inch scar (left photo) and a smaller one show where melanoma or Exposure to UV radiation—whether pre-cancerous moles have been removed from Cicala’s body. from the sun or from artificial sources such as sunlamps used in tanning

1 / FDA Consumer Health Information / U.S. Food and Drug Administration MAY 2010 Consumer Health Information www.fda.gov/consumer

Melanoma, the deadliest form of skin cancer, is linked to getting severe sunburns, especially at a young age. beds—increases the risk of devel- analyzed the review. Limitations controlled. But there is no evidence oping skin cancer, according to the include possible inaccuracy of peo- to support these claims. In fact, sun- National Cancer Institute (NCI). Mel- ple’s memories of their tanning expe- lamps may be more dangerous than anoma, the deadliest form of skin riences, not knowing the amount of the sun because they can be used at cancer, is linked to getting severe UV radiation emitted by each tanning the same high intensity every day of sunburns, especially at a young age. device, and the inability to separate the year—unlike the sun whose inten- In July 2009, the International the effects of individuals’ indoor sity varies with the time of day, the Agency for Research on Cancer and outdoor exposure. Nevertheless, season, and cloud cover. (IARC), part of the World Health IARC concluded that there is con- Organization, concluded that tan- vincing evidence of an association Tanning in Children and Teens ning devices that emit UV radia- between the use of indoor tanning FDA is particularly concerned about tion are more dangerous than pre- equipment and melanoma risk, and children and teens being exposed to viously thought. IARC moved these that the use of tanning beds should UV rays. Intermittent exposures to devices into the highest cancer risk be discouraged. intense UV radiation leading to sun- category: “carcinogenic to humans.” “It’s well established that UV radia- burns, especially in childhood and Previously, it had categorized the tion from the sun causes skin can- teen years, increase the risk of mela- devices as “probably carcinogenic to cer,” says Miller. “Since lamps used noma, according to NCI. humans.” in tanning beds emit UV radiation, FDA believes that limiting sun Development of cancer is a long the use of indoor tanning devices also exposure and using sunscreen or process that may take decades. There- increases your risk of skin cancer.” sunblock are particularly important fore, IARC also recommended ban- for children since these measures can ning commercial indoor tanning for Other Risks prevent sunburn at a young age. those younger than 18 years to pro- In addition to the serious risk of skin NCI reports that women who use tect them from the increased risk for cancer, tanning can cause: tanning beds more than once a month melanoma and other skin cancers. • Premature aging. Tanning causes are 55 percent more likely to develop IARC’s conclusions and recommen- the skin to lose elasticity and wrin- melanoma. Teenage girls and young dations were based on its 2006 review kle prematurely. This leathery look women make up a growing number of 19 studies conducted over 25 years may not show up until many years of tanning bed customers. on the use of indoor tanning equip- after you’ve had a tan or sunburn. “Young people may not think they ment. The review found evidence of • Immune suppression. UV-B radia- are vulnerable to skin cancer,” says • an association between indoor tan- tion may suppress proper function- Kaczmarek. “They have difficulty ning and two types of skin can- ing of the body’s immune system thinking about their own mortality.” cer: squamous cell carcinoma and and the skin’s natural defenses, Yet of the more than 68,000 people melanoma leaving you more vulnerable to dis- in the United States who will learn • an association between UV-emit- eases, including skin cancer. they have melanoma this year, one ting tanning devices and cancer of • Eye damage. Exposure to UV radia- out of eight will die from it, accord- the eye (ocular melanoma) tion can cause irreversible damage ing to NCI estimates. In addition, the • both UV-A and UV-B rays causing to the eyes. American Academy of Dermatology DNA damage, which can lead to • Allergic reaction. Some people reports that melanoma is the second skin cancer in laboratory animals who are especially sensitive to UV most common cancer in women 20 and humans radiation may develop an itchy red to 29 years old. • the risk of melanoma of the skin rash and other adverse effects. Some states are considering laws to increasing by 75 percent when tan- ban those under age 18 from using ning bed use started before age 35 Advocates of tanning devices some- tanning beds. And many states now times argue that using these devices have laws that require minors to have IARC’s review had some limita- is less dangerous than sun tanning a parent’s consent or be accompanied tions, says Ron Kaczmarek, M.D., because the intensity of UV radiation by a parent to the tanning facility. M.P.H., an FDA epidemiologist who and the time spent tanning can be FDA’s current performance standard

2 / FDA Consumer Health Information / U.S. Food and Drug Administration MAY 2010 Consumer Health Information www.fda.gov/consumer

Since lamps used in tanning beds emit UV radiation, the use of indoor tanning devices also increases your risk of skin cancer. requires that a sunlamp product’s studies found that the UV exposures not realize your skin is burned until label include a recommended expo- typically provided by sunlamp prod- it’s too late. sure schedule. FDA has advised man- ucts are excessive, and that compara- • Failing to follow manufacturer- ufacturers that this schedule should ble cosmetic effects can be produced recommended exposure times on provide for exposures of no more than with exposures that are only one- the label for your skin type. three sessions in the first week. third or even one-fourth the levels • Tanning while using certain medi- In an NCI-sponsored study pub- currently used. FDA is evaluating the cations or cosmetics that may make lished in September 2009 in the results of this research and consid- you more sensitive to UV rays. Talk Archives of Dermatology, the study ering whether those results warrant to your doctor or pharmacist first. researchers hired and trained col- changes to its performance standard lege students to pose as 15-year-old, for sunlamp products. fair-skinned girls who had never FDA held an advisory committee tanned before. By telephone, the stu- meeting in March 2010 to seek inde- This article appears on FDA’s Con- dents asked more than 3,600 tanning pendent, professional expertise and sumer Updates page (www.fda.gov/ facilities in all 50 states about their advice on regulatory issues related ForConsumers/ConsumerUpdates), practices. to tanning devices. At this public which features the latest on all FDA- Less than 11 percent of the facili- meeting, the agency heard many sug- regulated products. ties followed FDA’s recommended gestions from health professionals, exposure schedule of three or fewer scientists, tanning industry repre- For More Information sessions the first week. About 71 per- sentatives, and consumers. Based on Sun Safety: Save Your Skin! cent said they would allow a teen to the recommendations of the advisory www.fda.gov/ForConsumers/ tan all seven days the first week, and committee and FDA’s own studies, ConsumerUpdates/ucm049090.htm many promoted frequent tanning the agency is considering revising with “unlimited tanning” discount some requirements for tanning beds, Tanning price packages. including strengthening the warning www.fda.gov/Radiation-Emitting About 87 percent of the facilities labels to make consumers more aware Products/RadiationEmittingProducts required parental consent, lead- of the risks. andProcedures/Tanning/default.htm ing the researchers to conclude that “many parents are allowing their The Riskiest Practices Report to Congress: Labeling teens to tan and are providing written FDA, NCI, the American Academy of Information on the Relationship consent or accompaniment.” Dermatology, and other health orga- Between the Use of Indoor Tanning “Parents should carefully consider nizations advise limiting exposure to Devices and Development of Skin the risks before allowing their chil- natural UV radiation from the sun and Cancer or Other Skin Damage dren under 18 to tan,” says Miller. avoiding artificial UV sources such as www.fda.gov/MedicalDevices/Device tanning beds entirely. RegulationandGuidance/Overview/ FDA Regulation All use of tanning beds increases the MedicalDeviceUserFeeand FDA regulates radiation-emitting risk of skin cancer. Certain practices are ModernizationActMDUFMA/ products, including sunlamps and especially dangerous. These include: ucm109288.htm products that contain them, such as • Failing to wear the goggles pro- tanning beds and booths and portable vided, which can lead to short- and What is Your Risk of Developing home units. Manufacturers of sun- long-term eye injury. Skin Cancer? lamps must comply with FDA regu- • Starting with long exposures (close www.skincarephysicians.com/ lations, including the performance to the maximum time for the par- skincancernet/risk.html standard for sunlamp products. ticular tanning bed), which can lead In a December 2008 Report to to burning. Because sunburn takes Congress, FDA noted that FDA/NCI 6 to 48 hours to develop, you may

3 / FDA Consumer Health Information / U.S. Food and Drug Administration MAY 2010