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’ve 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 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 melanomaBrit 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.

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-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.

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.

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.

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.

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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 adolescentsPediatrics 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.

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.

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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. 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.

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 skinAdv 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.

Skin Cancer Foundation Statement: At a time when skin cancer is occurring at the highest levels in decades, any legislation that limits options for effective sun protection is cause for concern. Laws banning products containing oxybenzone and other ultraviolet (UV) filters will undermine years of education and awareness about the importance of sun protection and create another hurdle for anyone trying to make sunscreen use a priority. The Skin Cancer Foundation encourages legislators to consider established science showing that UV rays increase the risk of skin cancer before making decisions to limit sun protection options.

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The Skin Cancer Foundation plays a major role in educating the public about effective sun protection for skin cancer prevention, including the daily use of sunscreen. Hawaii, the U.S. Virgin Islands and Key West, Florida, are among several places that have proposed or enacted bans on sunscreen products containing ingredients permitted under the current FDA monograph. (However, in March, Florida legislation was introduced that, if the governor signs, will prohibit local governments from regulating sunscreens or other over-the-counter drugs. That would mean the law won’t go into effect in January 2021 as scheduled.) Still, several additional local governments have legislation in the works, adding to the number of people who could find their sunscreen choices limited. The Foundation offers the following recommendations to residents of areas that have enacted bans on oxybenzone and other organic ingredients:

Everyone needs sunscreen, every day and everywhere. Even incidental exposure damages skin and can lead to skin cancer. There is well-established evidence that regular daily use of an SPF 15 or higher sunscreen reduces the risk of developing melanoma and nonmelanoma skin cancer.

Places near the equator, like Hawaii, receive more intense UV rays than most other regions. This makes sun protection even more important, especially for tourists. Periodic, concentrated exposure to UV radiation (such as the kind received on a tropical vacation) frequently causes sunburn and severely damages the skin, increasing the risk of developing melanoma.

Anyone who will experience extended exposure to the sun should apply a broad-spectrum, SPF 30 or higher sunscreen. Look for water-resistant formulas, which are labeled to protect for up to 40 or 80 minutes while swimming or sweating before needing reapplication. If you are in an area that has banned products with oxybenzone and octinoxate, your options may be limited, but it is important that you find products that achieve the guidelines above. You can do it.

Sunscreen alone isn’t enough. Since its inception in 1979, the Foundation has recommended following a complete sun protection regimen that includes seeking shade and covering up with clothing, including a wide-brimmed hat and UV-blocking sunglasses, in addition to daily sunscreen use. Clothing is the most effective form of sun protection, and swim shirts, rash guards and wet suits offer great protection during water activities, especially in intense UV environments like Hawaii. Look for clothing and hats labeled with an ultraviolet protection factor (UPF) rating of 30 or higher to ensure effective protection. For more information about skin cancer prevention and sun protection, visit SkinCancer.org.

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.