Indoor tanning is big business, with tanning trade publications reporting this as a $2 billion-a-year industry in the United States. According to industry estimates, 28 million Americans are tanning indoors annually at about 25,000 tanning salons around the country. In fact, a recent study of more than 10,000 teens across the US found that tanning bed use was increasing, especially among adolescent girls.

This does not bode well for the health of the nation. In 1994, a Swedish study found that women 18-30 years old who visited tanning parlors 10 times or more a year had seven times greater incidence of melanoma than women who did not use tanning salons. In another study, people exposed to 10 full-body tanning salon sessions had a significant increase in skin repair proteins typically associated with sun damage, indicating that ultraviolet (UV) radiation from indoor tanning is as dangerous as UV from the sun. And in 2002, a study from Dartmouth Medical School found that tanning device users had 2.5 times the risk of squamous cell carcinoma and 1.5 times the risk of basal cell carcinoma. And yet, even with all this evidence, the tanning salons remain unrepentant.

The tanning industry relies on two misleading arguments: first, that since melanoma is mainly caused by sunburn, "controlled" tanning helps prevent melanoma by building up the protective pigment melanin; second, that UV exposure makes the skin produce vitamin D, which helps prevent breast, prostate and colon cancer, as well as other diseases.

Medical experts refute these arguments. They point out that our diet (especially vitamin D-rich foods such as dairy products and salmon) generally provides all the vitamin D we need. Furthermore, tanning to increase melanin is counterproductive. Tanning, like burning, causes genetic damage to skin cells. "You can't protect the skin by damaging it," said James M. Spencer, MD, director of dermatologic surgery at Mount Sinai Medical Center in New York City. "Tanning not only increases the risk for melanoma and squamous cell carcinoma, but accelerates skin aging."

There have been several attempts made to regulate the industry, by physician groups as well as state and national congresspeople and the World Health Organization, with limited success. The FDA is weighing stricter controls over tanning devices, but has not yet instituted any changes. The tanning industry has fought all of these measures. "Tanning manufacturers and salon owners keep lobbying the FDA and state agencies to soften regulations, claiming that tanning is healthful," said Dr. Spencer.

Unfortunately, even when regulation has occurred, it hasn't solved the problems. "Regulation can't make tanning safe," declared Michael Franzblau, MD, clinical professor of dermatology, University of California School of Medicine, San Francisco. "Banning salons is the only answer."

He should know, because he was instrumental in the passage of legislation regulating tanning facilities in California. The law, passed in 1988, unfortunately had no mechanism for registration of tanning parlors or collection of fees from owners. "Hence, there is no enforcement," notes Dr. Franzblau.

Some states require salons to provide UV-protective eyewear or have machine operators remain present throughout a client's session. Others require a sign on the booth warning people who always sunburn that tanning puts them at high risk for skin damage. Whatever the regulations, says Dr. Franzblau, there's no assurance they will be complied with. "I've taken teams of scientists into salons where not one requirement was being followed." Other studies have shown that tanning salons frequently exceed "safe" UV limits. The average salon patron in North Carolina was recently found to exceed FDA limits by 95 percent.

Is banning salons outright the only answer? Dr. Franzblau believes that eliminating tanning salons "would be 100 percent more effective" than regulating them. And it could save millions of lives.