Indoor Tanning and Melanoma: A Direct Link

1. Indoor Tanning and Melanoma: A Direct Link Darrell S. Rigel, MD Clinical Professor, New York University Medical School Past President – American Society for Dermatologic Surgery

2. American Society for Dermatologic Surgery • 5200 members who diagnose and treat skin cancers • Members performed over 3.1 million skin cancers procedures last year, a 55% increase over 2005 * • Regularly see people who have been exposed to tanning beds develop skin cancer *ASDS Survey – Perceptions Solutions 2009

3. UV is a carcinogen • UVB – “complete” carcinogen • Energy is directly absorbed by DNA • Pyrimidine dimer formation • UVA – “indirect” carcinogen • Excites chromophores and generates free radicals  DNA strand breaks • UV listed as known carcinogen by FDA • WHO classified UV tanning beds as “carcinogenic to humans” Matsumura et al, Toxicol Applied Pharmcol, 2004 http://ntp.niehs.nih.gov/ntp/roc/eleventh/profiles/s183uvrr.pdf, 2005 Lancet Oncology, Aug 2009.

4. Is increased melanoma risk associated with tanning bed usage?

5. Sunburns, Tanning Bed Usage and MM • 413 MM patients vs. 416 controls • Risk factors for the development of MM were 10 or more sunburns and tanning bed use in fair skinned young subjects • Conclusion: • Melanoma risk increased in tanning bed users • Risk may be underestimated due to only mean lag time in study of 7 years from tanning bed exposure to MM Bataille et al, Eur J Cancer, 2004

6. Risk Factors for MM in WomenTanning Beds, Sun Exposure, Pigmentation • 106,379 Scandinavian women with 8 years of FU • 187 MM diagnosed during study interval • Factors that significantly influenced MM risk: • larger body surface area • number of nevi on legs • red hair • sunburns per year • use of tanning beds >= once a month • Conclusion: • Tanning bed use influences Melanoma risk • Full effects of exposure may not yet be seen Veierod et al, JNCI, 2003

7. Tanning and Melanoma Risk • Significantly increased risk of developing MM (OR=1.8) for persons exposed to UV tanning beds even after accounting for other risk factors by multivariate analysis • Conclusion: • Significant association with tanning and the later development of Melanoma Westerdahlet al, Br J Cancer, 2000

8. Tanning Salons and MM Risk • 200 MM pts with 804 controls from the Nurse Health Study • RR = 2.1 for ever vs. never tanning salon usage • Conclusion: • Tanning bed use associated with Melanoma Han et al, Int J Epidemiol, 2006

9. Tanning beds and Melanoma Risk • 10 studies comparing “ever” vs. “never” exposed to UV tanning beds • MM risk OR=1.25 ever using a tanning bed • Conclusion: • Significant association with “ever” tanning in UV tanning beds and the later development of Melanoma Gallagheret al, Cancer Epidemiol Biomarkers Prev, 2005

10. Tanning and Melanoma Risk • 1518 dermatology pts surveyed for skin cancer history and tanning bed usage • MM risk OR 1.64 ever using a tanning bed • OR=3.2 for women <45 (OR=4.2 if tanning sessions >20 mins) • Conclusion: • Significant association with tanning and the later development of Melanoma (especially in younger women) Ting et al, Int J Dermatol, 2007

11. Tanning and Melanoma Risk • 423 cases of MM vs. 678 controls for tanning and sunlamp usage • MM risk OR 1.39 ever using a sunlamp and 1.14 ever using a tanning bed • Latency may not yet be long enough to see full effect of risk for developing MM • Conclusion: • Significant association with tanning and the later development of Melanoma Clough-Corret al, Cancer Causes Control, 2008

12. Tanning Bed use and MM risk • Meta-analysis of 19 studies • RR 1.15 for MM with tanning bed use • RR 1.75 if tanning began prior to age 35 • Evidence does not support a protective effect of the use of tanning beds against damage to the skin from subsequent sun exposure • Conclusion: • Young adults should be discouraged from using indoor tanning equipment and restricted access to tanning beds by minors should be strongly considered Green et al, Int J Cancer, 2007

13. Tanning Beds and MM RiskRisk of Multiple vs. Single Primary MM • 531 MM patients (125 Multiple/406 single) • 152 reported prior tanning bed usage • Results • Adjusted for natural UV (sun) exposure history • OR = 1.68 for Tanning Bed usage • First exposure before age 20 (OR = 2.6) • Conclusion: • Significant association of Melanoma risk and UV-emitting tanning beds Chiu et al, World Congress on Melanoma, 2005

14. Dermatologists are seeing: • More melanomas in young women… • in anatomic sites where the “sun doesn’t shine” • Something that was very rarely seen a decade ago • Virtually every one of these young women with melanoma that I see have a significant indoor tanning history!

15. Invasive MM Rate/100,000 vs. Age –US Males SEER 2006

16. Invasive MM Rate/100,000 vs. Age –US Males SEER 2006

17. Invasive MM Rate/100,000 by Age – US Females SEER 2006

18. Invasive MM Rate/100,000 by Age – US Females SEER 2006

19. The ASDS Requests the FDA to: • Ban the use and sale of tanning devices in the US • If this cannot be done: • Reclassify tanning devices to the strongest possible category • Restrict access to tanning beds by minors • Require posted warning statements • Require informed consent for all consumers • Implement and enforce labeling recommendations from the TAN Act • Enforce additional state regulations