Skin Cancer Issues and 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’ve include references to relevant studies and articles, which you can find under “Related Reading and Evidence-Based Research Studies.”

Click on the topics below to read our position statements and lists of related reading

  • 1. The Link Between Sun Exposure and Melanoma

    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.

    More Information:

    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 2010Br 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 controlsInt 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 exposureEur 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 studyJ Dermatol Surg Onc 1983; 12:981-6.

  • 2. The Link Between Indoor Tanning Bed Use and Melanoma

    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.

    More Information:

    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-analysisBrit 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 cancerJ 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 melanomaInt 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 cancersJ Natl Cancer Inst 2002; 94:224. doi:10.1093/jnci/94.3.224.

    Swerdlow AJ, Weinstock, MA. Do tanning lamps cause melanoma? An epidemiologic assessmentJAM Acad Derm 1998; 38(1):89-98.

  • 3. U.S. Food and Drug Administration’s (FDA) Final Order to Reclassify Tanning Beds

    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.

    More Information:

    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. Accessed Oct 7, 2011.

    World Health Organization. Sunbeds, tanning and UV exposure Fact sheet N°287.
    Interim revision April 2010. Accessed Oct 7, 2011.

  • 4. The Role of Sunscreen in Prevention of Premature Skin Aging

    A June 2013 study reveals strong evidence that daily sunscreen use significantly slows skin aging, even in middle-aged men and women. Specifically, the findings show that subjects who applied an SPF of 15+ broad-spectrum (UVA/UVB) sunscreen every morning (and reapplied sunscreen after sweating, bathing or spending more than a few hours outdoors), reduced their skin aging by 24 percent.

    More than 90 percent of the visible skin changes associated with aging are caused by the sun’s ultraviolet rays.

    Skin Cancer Foundation Statement: This study makes the case even stronger for daily sunscreen use as part of a complete sun protection regimen that also includes seeking shade and covering up with protective clothing including wide-brimmed hats and UV-blocking sunglasses.

    Related Reading and Evidence-Based Research Studies:

    Hughes MCB, Williams GM, Baker P, Green AC. Sunscreen and prevention of skin aging: a randomized trial. Ann Intern Med 2013 June; 158 (11):781-790.

    Gilchrest BA. Skin and aging process. CRC Press. 1984; 124.

    Godar DE, Urbach F, Gasparro FP, Van der Leun JC. UV doses of young adults. Photochem Photobiol 2003; 77(4):453-457.

  • 5. Vitamin D Deficiency and the Sun

    Skin Cancer Foundation Statement: There are three sources of vitamin D: exposure to the sun’s UVB radiation, certain foods, and supplements. The Skin Cancer Foundation recommends that everyone obtain the recommended daily 600 International Units (IU) through a combination of diet and supplements. The limited benefits of exposure to UVB radiation cannot be separated from the sun’s harmful effects, including an increased risk of skin cancers, premature skin aging and a weakened immune system.

    More Information:

    Vitamin D is essential for strong bones and a healthy immune system, and the Institute of Medicine recommends that people ages 1-70 receive 600 IU a day. There has been much speculation on the other benefits vitamin D may offer, but after a review of more than 1,000 studies, in 2010 the Institute determined that evidence about the vitamin’s ability to prevent other health problems was inconclusive.

    Vitamin D can be obtained from oily fish (salmon, mackerel, sardines) and cod liver oil as well as from fortified orange juice and milk, yogurts, and cereals such as Kashi® U™, Grape-Nuts and Total®. Supplements are readily available and inexpensive.

    While obtaining vitamin D from the sun’s UVB rays may at first sound simpler, in fact it is not. Overexposure to UVB actually contributes to the breakdown of vitamin D in the body. After limited UVB exposure (determined by season, time of day, skin type and latitude; approximately five minutes daily for a Caucasian in New York City at 12 PM in the summer), the body’s vitamin D production reaches its maximum. Further UV exposure will not result in more vitamin D, but will instead prompt its disintegration into inactive compounds.

    Related Reading and Evidence-Based Research Studies:

    Office of Dietary Supplements. Dietary supplement fact sheet: vitamin D. National Institutes of Health. Reviewed June 24, 2011. Accessed Oct. 24, 2011.

    Balk SJ. Council on Environmental Health; Section on Dermatology. Ultraviolet radiation: a hazard to children and adolescents. Pediatrics 2011; 127(3):e791-817. Epub 2011 Feb 28.

    Institute of Medicine of the National Academies. Report brief: dietary reference intakes for calcium and vitamin D. Nov. 30, 2010. Accessed Oct. 10, 2011.

    Brightman L, Hamann G, Geronemus R. The vitamin D dilemmaThe Skin Cancer Foundation J 2008; (26):29-31.

  • 6. The Role of Sunscreen in Preventing Skin Cancers, Including Melanoma

    Skin Cancer Foundation Statement: Landmark research has provided evidence of the value of sunscreen use in preventing melanoma and other skin cancers. The Skin Cancer Foundation considers sunscreen one vital part of a comprehensive sun safety program, along with shade and sun-protective clothing, including long-sleeved shirts, long pants, a wide-brimmed hat and UV-blocking sunglasses.

    More Information:

    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. Not until recently was there strong evidence also pointing to daily sunscreen use playing a role in melanoma prevention. The smoking gun comes via a rigorous study of more than 1,600 adults over the course of a decade. Researchers determined that subjects applying 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 preventionCancer 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 useCancer 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 trialLancet 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.

  • 7. U.S. Food and Drug Administration (FDA) Final Sunscreen Regulations

    Skin Cancer Foundation Statement: The Skin Cancer Foundation applauds the FDA for issuing its final regulations on sunscreens in 2011. The FDA’s announcement is a boon for consumers, drawing attention to and acknowledging the importance of UVA protection in the prevention of skin cancer.

    More Information:

    Sun protection is an important public health issue, with more than 3.5 million skin cancers in over two million people diagnosed annually in the US. The vast majority of skin cancers are associated with exposure to UV radiation from the sun, and sunscreen is an integral part of a comprehensive sun protection regimen. Although science and technology have advanced over the past several years to dramatically improve the efficacy of sunscreens, there has long been a need to update the governmental regulations associated with them — particularly in the areas of ultraviolet A (UVA) radiation protection and product labeling.

    UVA rays, along with ultraviolet B (UVB) rays, are the sun’s wavelengths that reach the earth; protection from both is essential. A sunscreen’s sun protection factor (SPF) measures protection from UVB rays, but until the FDA released its final regulations, which include requirements for the testing and labeling of UVA-screening products, there were no official, standardized methods for measuring or indicating UVA protection. Protection from UVA rays is vital, because while UVB rays cause sunburn, UVA rays are the prime cause of premature skin aging, and both rays cause skin cancer. Under the new guidelines, consumers are assured that sunscreens labeled as both “Broad Spectrum” and “SPF 15” (or higher) not only protect against sunburn, but, if used as directed with other sun protection measures, can reduce the risk of skin cancer and early skin aging. All sunscreens labeled in this way offer effective protection against both UVA and UVB rays.

    Related Reading and Evidence-Based Research Studies:

    U.S. Food and Drug Administration. Questions and answers: FDA announces new requirements for over-the-counter (OTC) sunscreen products marketed in the U.S. Updated June 27, 2011. Accessed Oct. 10, 2011.

    U.S. Food and Drug Administration. Sunscreen drug products for over-the-counter human use; final rules and proposed rules. Published June 17, 2011. Accessed Oct. 10, 2011.

    Wang SQ, Lim HW. Current status of the sunscreen regulations in the United States: 2011 Food and Drug Administration’s final rule on labeling and effectiveness testingJ Am Acad Dermatol 2011; 65(4): 863-869.

    Rogers, HW, Weinstock, MA, Harris, AR, et al. Incidence estimate of nonmelanoma skin cancer in the United States, 2006Arch Dermatol 2010; 146(3):283-287.

  • 8. The Safety of Nanotechnology

    Skin Cancer Foundation Statement: By reducing the particles of the sunscreen ingredients titanium dioxide and zinc oxide to tiny, “micronized” or “nanosize” particles, sunscreen manufacturers are able to eliminate the white, pasty look associated with these ingredients, making sunscreen products appear more natural on the skin. The concern is that nano-sized sunscreen particles could penetrate the skin and damage living tissue. However, this is not the case: sunscreens are applied to the outermost layer of skin, which is made up of dead skin cells. Several studies have shown that nanoparticles do not penetrate intact living skin. Therefore they pose no risk to human health.

    Related Reading and Evidence-Based Research Studies:

    Wang SQ, Tooley IR. Photoprotection in the era of nanotechnologySemin Cutan Med Surg 2011; 30(4):210-3.

    Mavon A, Miquel C, Lejeune O, Payre B, Moretto P. In vitro percutaneous absorption and in vivo stratum corneum distribution of an organic and a mineral sunscreenSkin Pharmacol Physiol 2007; 20:10-20.

    Gamer AO, Leibold E, van Ravenzwaay B. The in vitro absorption of microfine zinc oxide and titanium dioxide through porcine skinToxicol In Vitro 2006; 20:301-307.

    Schulz J, Hohenberg H, Pflücker F, et al. Distribution of sunscreens on skin. Adv Drug Deliv Rev 2002; 54 (Suppl. 1): S157-S163.

    Pflucker F, Wendel V, Hohenberg H, et al. The human stratum corneum layer: an effective barrier against dermal uptake of different forms of topically applied micronised titanium dioxideSkin Pharmacol Appl Skin Physiol 2001; 14 (Suppl. 1): 92-97

    Laderman J, et al. Penetration of titanium dioxide microparticles in a sunscreen formulation into the horny layer and the follicular orificeSkin Pharmacol Appl Skin Physiol 1999; 12:247-256.

    Lansdown AB, Taylor A. Zinc and titanium oxides: promising UV-absorbers but what influence do they have on the intact skin? Int J Cosmet Sci 1997; 19:167-172.

Updated January 2014