The parallels between smoking and tanning are remarkable, and knowledge of their dangers followed a similarly tortuous path to reach the full light of day. In both cases, those who stood to profit long denied their impact on health, but evidence accumulated over decades ultimately made their carcinogenicity undeniable. The difference is, the deadly truth about smoking was firmly and legally established by the 1990s, while the truth about tanning has become inescapable only in the past few years (even as its indoor purveyors still issue protestations to the contrary).
In this issue of The Melanoma Letter, Alan Geller and Drs. Hawryluk and Fisher summarize the research published over the past two decades (with emphasis on the wave of convincing studies in the past three years) that has provided compelling evidence of tanning’s link to melanoma and other skin cancers. Given what now seems to be incontestable proof that indoor tanning significantly raises melanoma risks, the authors argue for increased regulation over the tanning industry — above all, limiting access to those who are most vulnerable, our youth. As the authors point out, more and more states and countries are taking such arguments to heart and banning indoor tanning for minors. In the US, the FDA is also considering raising the hazard classification of tanning beds, thereby mandating greater surveillance, stiffer controls, and warning labels. If enforced,these actions could engrain in everyone’s minds the dangers of artificial tanning the same way warning labels and banned sale to minors did when it came to smoking.
But changing hearts and minds will be complex. Just as lighting up was once the epitome of cool, a tan remains for many young people the symbol of health and beauty. Paradoxically, these young tanners are more knowledgeable than ever about the dangers, but often this does not change their behavior — the quest for cool, the desire to “belong,” and the need to be attractive hold sway. Hopefully, the preponderance of scientific proof, unflagging public education, and reduced access will have the same effect that the war on smoking did, making it marginal. Already, with numerous celebrities speaking out about the dangers (and especially the aging effects) of tanning, we can envision a time when attitudes shift towards making one’s natural skin color the desired norm.
The last piece of the puzzle may prove the most difficult. Even if all of the above conspire to discourage tanning, once the habit starts, it is extremely hard to break. The reason may surprise some: like smoking, tanning is physically addictive. In our second story, Jean-Phillip Okhovat and Dr. Steven Feldman scrupulously trace the recent in vitro and in vivo research that has led scientists to this conclusion. This new knowledge could be the first step toward developing treatments — interventions to help people stop what we now know is an addictive behavior that could kill them before their time.
Allan C. Halpern, MD
Ashfaq A. Marghoob, MD