Skin Cancer Issues & Research
The Skin Cancer Foundation's position statements on controversial topics with supporting evidence-based research studies
The Skin Cancer Foundation receives many questions about sun protection and skin cancer prevention. The safety of certain sunscreen ingredients, the link between indoor tanning and skin cancer, and the role of vitamin D are among the most popular — and debated —subjects for our readers and members of the media. Here, we share our positions on some common controversies.
Our position statements are supported by scientific research that has been published in medical journals after review by experts in the field. We include references to relevant studies and articles, which you can find under “Related Reading and Evidence-Based Research Studies.”
Skin Cancer Foundation Statement: It’s estimated that 86 percent of all melanomas are caused by exposure to ultraviolet (UV) radiation from the sun. While genetics and family history also play a role, a pattern of sun exposure is a definite factor in the majority of melanomas.
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Intense UV radiation exposure (the kind you may get on a sun-drenched holiday after spending many months indoors) is linked with an increased risk of melanoma, research has shown. Intense UV exposure often causes sunburn, and just one blistering burn in childhood or adolescence (or a total of five sunburns sustained by any age) more than doubles a person’s chances of developing melanoma later in life.
Related Reading and Evidence-Based Research Studies:
Parkin DM, Mesher D, Sasieni P. Cancers attributable to solar (ultraviolet) radiation exposure in the UK in 2010. Br J Cancer 2011; 105:566-69.
Pleasance ED, Cheetham RK, Stephens PJ, et al. A comprehensive catalogue of somatic mutations from a human cancer genome. Nature 2010; 463:191-96.
Chang YM, Barrett JH, Bishop DT, et al. Sun exposure and melanoma risk at different latitudes: a pooled analysis of 5700 cases and 7216 controls. Int J Epidemiol 2009; 38(3):814-30. Epub 2009 Apr 8.
Gandini S, Sera F, Cattaruzza MS, et al. Meta-analysis of risk factors for cutaneous melanoma: II. sun exposure. Eur J Cancer 2005; 41(1):45-60.
Pfahlberg A, Kolmel KF, Gefeller O. Timing of excessive ultraviolet radiation and melanoma: epidemiology does not support the existence of a critical period of high susceptibility to solar ultraviolet radiation-induced melanoma. Brit J Dermatol 2001; 144:3:471.
Lew RA, Sober AJ, Cook N, Marvell R, Fitzpatrick TB. Sun exposure habits in patients with cutaneous melanoma: a case study. J Dermatol Surg Onc 1983; 12:981-6.
Skin Cancer Foundation Statement: Studies offer dramatic evidence that indoor tanning bed use increases the risk of melanoma, the deadliest form of skin cancer. Those who begin tanning before age 35 increase their risk by almost 75 percent. Any suggestion that tanning beds are safe is putting people’s lives in danger.
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The International Agency for Research on Cancer, affiliated with the World Health Organization, has determined that UV radiation-emitting tanning devices are cancer-causing in humans. While many members of the medical community had long believed that UV radiation from indoor tanning is carcinogenic, it had been difficult to verify the association between indoor tanning and melanoma incidence until recently. Additionally, those who have ever tanned indoors have a 69 percent risk of developing basal cell carcinoma before age 40.
Related Reading and Evidence-Based Research Studies:
Boniol M, Autier P, Boyle P, Gandini S. Cutaneous melanoma attributable to sunbed use: systematic review and meta-analysis. Brit Med J 2012; 345:e4757. Doi: 10.1136/bmj.e4757.
Zhang M, Qureshi AA, Geller AC, Frazier L, Hunter DJ, Han J. Use of tanning beds and incidence of skin cancer. J Clin Oncol 2012; 30(14):1588-93.
National Toxicology Program. Report on Carcinogens, Twelfth Edition. U.S. Department of Health and Human Services, Public Health Service, National Toxicology Program. 2011: 429-430. Accessed February 12, 2012.
Cust AE, Armstrong BK, Goumas C, et al. Sunbed use during adolescence and early adulthood is associated with increased risk of early-onset melanoma. Int J Cancer 2011; 128(10):2425-35. doi: 10.1002/ijc.25576.
Ferrucci LM, Cartmel B, Molinaro AM, Leffell DJ, Bale AE, Mayne ST. Indoor tanning and risk of early-onset basal cell carcinoma. Journal of American Academy of Dermatology. 2011.
The International Agency for Research on Cancer Working Group. The association of use of sunbeds with cutaneous malignant melanoma and other skin cancers: a systematic review. Int J Canc 2006; 120:1116-1122.
World Health Organization. Sunbeds, tanning and UV exposure Fact sheet N°287. Interim revision April 2010. Accessed Oct 7, 2011.
El Ghissassi F, Baan R, Straif K, et al. WHO International Agency for Research on Cancer Monograph Working Group. A review of human carcinogens–part D: radiation. Lancet Oncol 2009; 10(8):751-2.
Karagas MR, Stannard VA, Mott LA, Slattery MJ, Spencer SK, Weinstock MA. Use of tanning devices and risk of basal cell and squamous cell skin cancers. J Natl Cancer Inst 2002; 94:224. doi:10.1093/jnci/94.3.224.
Swerdlow AJ, Weinstock, MA. Do tanning lamps cause melanoma? An epidemiologic assessment. JAM Acad Derm 1998; 38(1):89-98.
The Skin Cancer Foundation supports any effort to raise awareness about the hazards of indoor tanning and applauds the FDA for taking the important step to reclassify ultraviolet (UV) tanning devices from class I (low to moderate risk) to class II (moderate to high risk) devices, which is a major step in skin cancer prevention.
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On May 29, 2014 the FDA issued a final order, reclassifying ultraviolet (UV) tanning devices from class I (low to moderate risk) to class II (moderate to high risk) devices. In addition, the FDA will require warning labels on these tanning devices, noting that they should not be used on persons under the age of 18. The order follows a March 2013 proposed order to reclassify ultraviolet (UV) tanning devices from class I medical devices (the same designation given to elastic bandages and tongue depressors) to class II devices.
Studies offer alarming evidence that indoor tanning bed use increases the risk of melanoma, the deadliest form of skin cancer. In fact, those who begin tanning before age 35 increase their risk by almost 75 percent.
Related Reading and Evidence-Based Research Studies:
Cust AE, Armstrong BK, Goumas C, et al. Sunbed use during adolescence and early adulthood is associated with increased risk of early-onset melanoma. Int J Cancer 2011 May 1; 128(10):2425-35. doi: 10.1002/ijc.25576
Lazovich D, Vogel RI, Berwick M, Weinstock MA, Anderson KE, Warshaw EM. Indoor tanning and risk of melanoma: a case-control study in a highly exposed population. Cancer Epidemiol Biomarkers Prev 2010 Jun; 19(6):1557-68. Epub 2010 May 26.
El Ghissassi F, Baan R, Straif K, et al. WHO International Agency for Research on Cancer Monograph Working Group. A review of human carcinogens–part D: radiation. Lancet Oncol 2009 Aug; 10(8):751-2.
Karagas MR, Stannard VA, Mott LA, Slattery MJ, Spencer SK, Weinstock MA. Use of tanning devices and risk of basal cell and squamous cell skin cancers.J Natl Cancer Inst 2002; 94:224; doi:10.1093/jnci/94.3.224.
Swerdlow AJ, Weinstock, MA. Do tanning lamps cause melanoma? An epidemiologic assessment. J Am Acad Derm 1998 Jan; 38(1):89-98.
U.S. Department of Health and Human Services. Report on Carcinogens twelfth edition, 2011. p.429-434. http://ntp.niehs.nih.gov/ntp/roc/twelfth/profiles/UltravioletRadiationRelatedExposures.pdf. Accessed Oct 7, 2011.
World Health Organization. Sunbeds, tanning and UV exposure Fact sheet N°287.
Interim revision April 2010. http://www.who.int/mediacentre/factsheets/fs287/en/. Accessed Oct 7, 2011.
Skin Cancer Foundation Statement: Landmark research has provided evidence of the value of sunscreen use in helping to prevent melanoma and squamous cell carcinoma. The Skin Cancer Foundation considers sunscreen one vital part of a comprehensive sun safety strategy, along with seeking shade and covering up with clothing, wide-brimmed hats, and UV-blocking sunglasses.
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For years there has been strong evidence that daily sunscreen use plays a role in lowering the risk of actinic keratosis, the most common skin precancer, and squamous cell carcinoma. In 2011, a rigorous study of more than 1,600 adults over the course of a decade found that daily sunscreen use also plays a role in melanoma prevention. The researchers determined that subjects who applied sunscreen with an SPF of 15 or higher daily reduced their risk of melanoma by 50 percent.
Related Reading and Evidence-Based Research Studies:
Green AC, Williams GM, Logan V, Strutton GM. Reduced melanoma after regular sunscreen use: randomized trial follow-up. J Clin Oncol 2011; 29(3):257-63.
Green AC, Williams GM. Point: sunscreen use is a safe and effective approach to skin cancer prevention. Cancer Epidem Biomar Prev 2007; 16(10):1921-22.
van der Pols JC, Williams GM, Pandeya N, Logan V, Green AC. Prolonged prevention of squamous cell carcinoma of the skin by regular sunscreen use. Cancer Epidemiol Biomar Prev 2006; 15(12):2546-8. Epub 2006 Nov 28.
Green A, Williams G, Neale R, et al. Daily sunscreen application and betacarotene supplementation in prevention of basal-cell and squamous-cell carcinomas of the skin: a randomised controlled trial. Lancet 1999; 354(9180):723-9.
Jolley D, Marks R, Thompson SC. Reduction of Solar Keratoses by Regular Sunscreen Use. New England Journal of Medicine 1993.
Skin Cancer Foundation Statement: Promoting sun protection has been a high priority for The Skin Cancer Foundation since it was founded in 1979, and the Foundation has always made recommendations based on the latest scientific evidence available. Sunscreen has been a central part of the Foundation’s sun safety recommendations. All sunscreen ingredients that are currently FDA-approved, including oxybenzone, have been used in the U.S. for many years, and there is no evidence that sunscreens with these ingredients are harmful to humans. The FDA’s recent calls for further research on the effects of absorption of certain ingredients are welcomed by The Skin Cancer Foundation. While we encourage further research on this topic, it is important that people continue to practice complete sun protection, including the use of sunscreens, as there is already substantial evidence showing that UV exposure is harmful and that sunscreen helps reduce skin cancer risk.
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In February 2019, the Food and Drug Administration (FDA) issued a proposed rule that updated regulatory requirements for sunscreens. Of the 16 currently marketed active ingredients, zinc oxide and titanium dioxide were generally recognized as safe and effective (GRASE) for use in sunscreens. PABA and trolamine salicylate were deemed NOT GRASE for use in sunscreens due to safety issues. There was insufficient safety data for the FDA to make a positive GRASE determination on the remaining 12 ingredients. To address those 12 ingredients, the FDA asked industry and other interested parties for additional data.
This declaration was alarming for many in the media and in the public, but the FDA itself pointed out that its “request for more data about these ingredients doesn’t mean the agency believes these products are ineffective or unsafe, or that these products should be removed from the marketplace. Rather, the agency asked for more data to help assess whether these products are safe and effective for regular use.”
More specifically, the proposed rule outlined concerns about the safety of sunscreen absorption into the body. While the FDA was not concerned about a small amount of absorption, if the amount of sunscreen absorbed was above a certain threshold (0.5ng/ml), it would need more detailed information about the safety of that ingredient.
The FDA published two studies, one in May 2019 and the other in January 2020, showing evidence that certain sunscreen ingredients (including avobenzone, oxybenzone and octocrylene) are absorbed into the body and exceed the minimal threshold for absorption. But in an editorial accompanying the research, the study authors note: “It is critical to recognize that these two studies conducted by the FDA do not provide any evidence that chemical sunscreens cause harm.”
The Skin Cancer Foundation encourages further research on the 12 sunscreen ingredients that have not yet been deemed GRASE, in hopes that additional data can help the FDA come to a conclusion about the safety of these UV filters. In the meantime, The Skin Cancer Foundation urges the FDA to take action in approving new sunscreen ingredients that could help diversify consumer choices.
While many sunscreen ingredients protect against damage from the sun’s UVB rays, which cause sunburn, oxybenzone is one of the few available in the U.S. that provides effective broad-spectrum protection against both UVB and the sun’s UVA rays, which can also cause sunburn as well as tanning, wrinkles and skin aging. Several ingredients available in other countries for years provide better UVA protection. However, they are not commercially available in the U.S., as they have been stuck in FDA review for nearly two decades. Since 2000, not a single new sunscreen ingredient has been added to the FDA’s approved list.
The Skin Cancer Foundation supported the federal Sunscreen Innovation Act (SIA), which was passed in 2014. The intention of SIA was to encourage the FDA to step up its process for reviewing new sunscreen ingredients, but the FDA has still not approved any to date. Innovation in sunscreen formulation will provide the public with more choices for sun protection, potentially leading to a decrease in the incidence of skin cancer.
Consumers who choose not to use products with oxybenzone or other chemical UV filters can purchase sunscreen products containing only the ingredients deemed GRASE by the FDA, zinc oxide and titanium dioxide. It should be noted that products only containing zinc oxide and titanium dioxide are not a perfect solution for everyone, as some may not achieve high SPF (sun protection factor) and broad-spectrum protection. Others may leave a whitish cast, especially on darker skin tones.
Americans deserve more choices, which is why the Foundation continues to support efforts to encourage the FDA to approve the use of new UV filters that are currently available outside the U.S. The Over-the-Counter Monograph Safety, Innovation and Reform Act, signed into law by President Trump in March 2020, is a promising first step toward making the approval process more efficient.
Finally, it’s important to keep in mind that sunscreen is just one part of a complete sun protection strategy. There are many ways to protect yourself from the sun, including seeking shade and covering up with clothing, wide-brimmed hats and UV-blocking sunglasses.