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Indoor Tanning and Risk of Melanoma: A Case-Control Study in a Highly Exposed Population
Open accessAbstract
Background: Indoor tanning has been only weakly associated with melanoma risk; most reports were unable to adjust for sun exposure, confirm a dose-response, or examine specific tanning devices. A population-based case-control study was conducted to address these limitations. Methods: Cases of invasive cutaneous melanoma, diagnosed in Minnesota between 2004 and 2007 at ages 25 to 59, were ascertained from a statewide cancer registry; age-matched and gender-matched controls were randomly selected from state driver's license lists. Self-administered questionnaires and telephone interviews included information on ever use of indoor tanning, types of device used, initiation age, period of use, dose, duration, and indoor tanning–related burns. Odds ratios (OR) and 95% confidence intervals (CI) were adjusted for known melanoma risk factors. Results: Among 1,167 cases and 1,101 controls, 62.9% of cases and 51.1% of controls had tanned indoors (adjusted OR 1.74; 95% CI, 1.42-2.14). Melanoma risk was pronounced among users of UVB-enhanced (adjusted OR, 2.86; 95% CI, 2.03-4.03) and primarily UVA-emitting devices (adjusted OR, 4.44; 95% CI, 2.45-8.02). Risk increased with use: years (P < 0.006), hours (P < 0.0001), or sessions (P = 0.0002). ORs were elevated within each initiation age category; among indoor tanners, years used was more relevant for melanoma development. Conclusions: In a highly exposed population, frequent indoor tanning increased melanoma risk, regardless of age when indoor tanning began. Elevated risks were observed across devices. Impact: This study overcomes some of the limitations of earlier reports and provides strong support for the recent declaration by the IARC that tanning devices are carcinogenic in humans. Cancer Epidemiol Biomarkers Prev; 19(6); 1557–68. ©2010 AACR.
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“The lower-energy UVA (315-400 nm), which constitutes ~95% of the ultraviolet energy that penetrates the atmosphere, also induces melanoma in mice and in humans who use tanning beds, but it is inefficient at making the cytosine-containing CPD that cause C→T mutations (12, 13).”
From Chemiexcitation of melanin derivatives induces DNA photoproducts long after UV exposure (2015) · cites this paper as [12]
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“Some studies have found a similar dose-dependent effect of indoor tanning independent of age166, although another found that tanning increased risk for young women167.”
From Mechanisms and prevention of UV‐induced melanoma (2018) · cites this paper as [166]
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“In addition, there is increasing evidence that artificial sources of UV exposure, including frequent indoor tanning, are associated with melanoma and other skin cancers.(12,43,44) Adolescents, especially white adolescent girls, commonly use indoor tanning: up to 37% of NHW female adolescents and 11% of NHW male adoles…”
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“Two newly published multicenter populationbased case-control studies provided further evidence of the risk of skin cancer and the use of indoor tanning devices.(53,54) One of the key differences in behavior between young men and women is that women are significantly more likely to use tanning beds than men.”
Jansen, R. M., Wang, S. Q., Burnett, M. E., Osterwalder, U., & Lim, H. W. (2013) · Journal of the American Academy of Dermatology · doi:10.1016/j.jaad.2013.08.021 · Cited by 97
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“The majority of melanomas (70%–80%), however, arise de novo, ie, with no associated nevus, and the majority of melanoma patients lack clinically atypical nevi or increased numbers of nevi (12,13).”
Youth Indoor Tanning and Skin Cancer Prevention
Seidenberg, A. B., Mahalingam‐Dhingra, A., Weinstock, M. A., Sinclair, C., & Geller, A. C. (2014) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2014.08.034 · Cited by 74
Self-citationAACR Cancer Progress Report 2013
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“Despite the overwhelming scientific evidence that tanning bed use increases an individual’s risk for developing cancer, particularly at a younger age (24, 25), tens of millions of Americans visit tanning salons each year (25).”
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“A commonly used definition of frequent tanning as indoor tanning at least 10 times in the past year (e.g., Guy et al., 2015) appears to be based on epidemiological research of cancer risk (e.g., Lazovich et al., 2010).”
BackgroundEpidemiological evidence that UVA radiation is involved in the genesis of cutaneous melanoma
Autier, P., Doré, J., Eggermont, A. M. M., & Coebergh, J. W. W. (2010) · Current Opinion in Oncology · doi:10.1097/cco.0b013e3283436e5d · Cited by 69
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Nielsen, K., Måsbäck, A., Olsson, H. L., & Ingvar, C. (2011) · International Journal of Cancer · doi:10.1002/ijc.26408 · Cited by 69
“Lazovich et al.7 as well as Cust et al.4 did, however, try to avoid this limitation by rigorously adjusting for sun exposure, and both found an association between CM and UVR exposure from sunbeds.”
BackgroundResultInfluentialTanning salons and skin cancer
Doré, J.-F., & Chignol, M.-C. (2012) · Photochemical & Photobiological Sciences · doi:10.1039/c1pp05186e · Cited by 66
An, S., Kim, K., Moon, S., Ko, K., Kim, I., Lee, J. E., & Park, S. K. (2021) · Cancers · doi:10.3390/cancers13235940 · Cited by 66
Current status of photoprotection by window glass, automobile glass, window films, and sunglasses
Almutawa, F., Vandal, R., Wang, S. Q., & Lim, H. W. (2013) · Photodermatology Photoimmunology & Photomedicine · doi:10.1111/phpp.12022 · Cited by 65
Indoor Tanning Among High School Students in the United States, 2009 and 2011
Guy, G. P., Berkowitz, Z., Tai, E. W., Holman, D. M., Jones, S. E., & Richardson, L. C. (2014) · JAMA Dermatology · doi:10.1001/jamadermatol.2013.7124 · Cited by 63
Efficacy of an Intervention to Alter Skin Cancer Risk Behaviors in Young Adults
Heckman, C. J., Darlow, S. D., Ritterband, L. M., Handorf, E. A., & Manne, S. L. (2016) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2015.11.008 · Cited by 63
Mayer, J. E., Swetter, S. M., Fu, T., & Geller, A. C. (2014) · Journal of the American Academy of Dermatology · doi:10.1016/j.jaad.2014.05.045 · Cited by 62
Sunbed use and campaign initiatives in the Danish population, 2007–2009: a cross‐sectional study
Køster, B., Thorgaard, C., Philip, A., & Clemmensen, I. H. (2011) · Journal of the European Academy of Dermatology and Venereology · doi:10.1111/j.1468-3083.2010.03960.x · Cited by 55
Kris, M. G., Benowitz, S. I., Adams, S., Diller, L., Ganz, P. A., Kahlenberg, M. S., Le, Q., Markman, M. M., Masters, G. A., Newman, L. A., et al. (2010) · Journal of Clinical Oncology · doi:10.1200/jco.2010.33.2742 · Cited by 54
A pilot study of genetic variants in dopamine regulators with indoor tanning and melanoma
Flores, K. G., Erdei, E., Luo, L., White, K. A., Leng, S., Berwick, M., & Lazovich, D. (2013) · Experimental Dermatology · doi:10.1111/exd.12200 · Cited by 52
Self-citationCognitive Rationalizations for Tanning-Bed Use: A Preliminary Exploration
Banerjee, S. C., Hay, J. L., & Greene, K. L. (2013) · American Journal of Health Behavior · doi:10.5993/ajhb.37.5.1 · Cited by 50
“In order to dissuade these tanning-bed users from using tanning beds in the future, 2 strategies may be useful for intervention purposes: (1) the appearance-based interventions that make the appearance-damage effects of tanning-bed use more salient9,40; and (2) tailoring of interventions to make them more personally r…”
BackgroundResultInfluentialTanning bed use and melanoma: Establishing risk and improving prevention interventions
Le Clair, M. Z., & Cockburn, M. G. (2016) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2015.11.016 · Cited by 50
“examined the individual effect of these devices on melanoma risk (Lazovich et al., 2010).”
BackgroundInfluentialSun Exposure and Protection Behaviors among Long-term Melanoma Survivors and Population Controls
Vogel, R. I., Strayer, L., Engelman, L., Nelson, H. H., Blaes, A. H., Anderson, K. E., & Lazovich, D. (2017) · Cancer Epidemiology Biomarkers & Prevention · doi:10.1158/1055-9965.epi-16-0854 · Cited by 48
“The Skin Health Study is described elsewhere (12).”
Self-citationPark, S. L., Marchand, L. L., Wilkens, L. R., Kolonel, L. N., Henderson, B. E., Zhang, Z., & Setiawan, V. W. (2012) · Cancer Prevention Research · doi:10.1158/1940-6207.capr-11-0460 · Cited by 47
“This increase has been hypothesized to be a result of the growing accessibility to recreational sun exposure (10, 11) and UV radiation (UVR) from tanning beds (12, 13); as well as increasing cancer surveillance and/or reporting (1).”
BackgroundDevelopment and Validation of the Comprehensive Indoor Tanning Expectations Scale
Noar, S. M., Myrick, J. G., Morales-Pico, B., & Thomas, N. E. (2014) · JAMA Dermatology · doi:10.1001/jamadermatol.2013.9086 · Cited by 46
Increases in invasive melanoma in England, 1979–2006, by anatomical site
Wallingford, S. C., Alston, R. D., Birch, J. M., & Green, A. C. (2011) · British Journal of Dermatology · doi:10.1111/j.1365-2133.2011.10434.x · Cited by 46
Preventing Skin Cancer Through Reduction of Indoor Tanning
Watson, M., Holman, D. M., Fox, K. A., Guy, G. P., Seidenberg, A. B., Sampson, B. P., Sinclair, C., & Lazovich, D. (2013) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2013.02.015 · Cited by 46
Self-citationDillard, A. J., Ferrer, R. A., & Welch, J. D. (2017) · Psychology and Health · doi:10.1080/08870446.2017.1380811 · Cited by 47
“Within the narrative, nine facts about skin cancer were presented, which were drawn from primary research (e.g. Lazovich et al., 2010) and agencies such as the National Cancer Institute (https://www.cancer.gov/types/skin).”
UVB and UVA irradiances from indoor tanning devices
Nilsen, L. T. N., Aalerud, T. N., Hannevik, M., & Veierød, M. B. (2011) · Photochemical & Photobiological Sciences · doi:10.1039/c1pp05029j · Cited by 45
Lostritto, K., Ferrucci, L. M., Cartmel, B., Leffell, D. J., Molinaro, A. M., Bale, A. E., & Mayne, S. T. (2012) · BMC Public Health · doi:10.1186/1471-2458-12-118 · Cited by 44
“Additionally, etiologic studies in younger populations with a high prevalence of indoor tanning show evidence of a dose-response relationship, with higher risk observed for increasing frequency and duration of indoor tanning for both melanoma [19,20] and BCC [18].”
BackgroundNovel Approaches in Melanoma Prevention and Therapy
Grimaldi, A. M., Cassidy, P. B., Leachman, S. A., & Ascierto, P. A. (2013) · Cancer treatment and research · doi:10.1007/978-3-642-38007-5_25 · Cited by 44
Embryonic signaling in melanoma: potential for diagnosis and therapy
Strizzi, L., Hardy, K. M., Kirsammer, G. T., Gerami, P., & Hendrix, M. J. C. (2011) · Laboratory Investigation · doi:10.1038/labinvest.2011.63 · Cited by 42
“Of note is the recent case–control study, demonstrating the strong correlation between exposure to artificial UVR associated with indoor tanning and risk of melanoma—regardless of age when indoor tanning began.(3) This provides clear evidence in support of classifying UVR as a human carcinogen.”
Carcioppolo, N., Dunleavy, V. O., & Yang, Q. (2016) · Health Communication · doi:10.1080/10410236.2015.1120697 · Cited by 41
“Exposure to indoor tanning during adolescence and early adulthood unequivocally contributes to carcinogenesis, and some estimates suggest that frequenting indoor tanning salons before the age of 35 years increases melanoma risk by 75% (Cust et al., 2011; Lazovich et al., 2010; Quinn et al., 2015; Zhang et al., 2012).”
BackgroundEarly-Onset Basal Cell Carcinoma and Indoor Tanning: A Population-Based Study
Karagas, M. R., Zens, M. S., Li, Z., Stukel, T. A., Perry, A. E., Gilbert‐Diamond, D., Sayarath, V., Stephenson, R. S., Barton, D. T., Nelson, H. H., et al. (2014) · PEDIATRICS · doi:10.1542/peds.2013-3559 · Cited by 40
Understanding quantitative research: part 1
Hoe, J., & Hoare, Z. (2012) · Nursing Standard · doi:10.7748/ns2012.12.27.15.52.c9485 · Cited by 38
Grant, W. B., Juzeniene, A., & Moan, J. E. (2010) · Scandinavian Journal of Public Health · doi:10.1177/1403494810382473 · Cited by 37
“[84] Lazovich D, Vogel RI, Berwick M, Weinstock MA, Anderson KE, Warshaw EM.”
BackgroundExposure to Indoor Tanning Without Burning and Melanoma Risk by Sunburn History
Vogel, R. I., Ahmed, R. L., Nelson, H. H., Berwick, M., Weinstock, M. A., & Lazovich, D. (2014) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/dju219 · Cited by 37
Self-citationUVA, UVB and incidence of cutaneous malignant melanoma in Norway and Sweden
Moan, J. E., Baturaite, Z., Porojnicu, A. C., Dahlback, A., & Juzeniene, A. (2011) · Photochemical & Photobiological Sciences · doi:10.1039/c1pp05215b · Cited by 37
Ultraviolet A radiation exposure and melanoma: a review
Fadadu, R. P., & Wei, M. L. (2022) · Melanoma Research · doi:10.1097/cmr.0000000000000857 · Cited by 40
Sunscreen and Melanoma: Is Our Prevention Message Correct?
Planta, M. B. (2011) · The Journal of the American Board of Family Medicine · doi:10.3122/jabfm.2011.06.100178 · Cited by 37
Tierney, P., Ferguson, J., Ibbotson, S. H., Dawe, R. S., Eadie, E., & Moseley, H. (2013) · British Journal of Dermatology · doi:10.1111/bjd.12181 · Cited by 35
Use of indoor tanning devices by high school students in the United States, 2009.
Guy, G. P., Tai, E. W., & Richardson, L. C. (2011) · Europe PMC (PubMed Central) · Cited by 35
Implementation of the Federal Excise Tax on Indoor Tanning Services in Illinois
Jain, N. (2012) · Archives of Dermatology · doi:10.1001/archderm.148.1.122 · Cited by 34
Kozma, B., & Eide, M. J. (2014) · Dermatologic Clinics · doi:10.1016/j.det.2014.03.004 · Cited by 34
Jagtap, D., Rosenberg, C. A., Martin, L. W., Pettinger, M. B., Khandekar, J. D., Lane, D. S., Ockene, I. S., & Simon, M. S. (2012) · Cancer · doi:10.1002/cncr.27497 · Cited by 33
An Intervention to Decrease Adolescent Indoor Tanning: A Multi-Method Pilot Study
Lazovich, D., Choi, K., Rolnick, C., Jackson, J. M., Forster, J., & Southwell, B. (2013) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2012.08.009 · Cited by 33
“Initiation of the behavior at a young age may increase the cumulative exposure, leading to greater likelihood of melanoma [9,10].”
BackgroundSelf-citationAACR Cancer Progress Report 2012
Cantley, L. C., Dalton, W. S., DuBois, R. N., Finn, O. J., Futreal, P. A., Golub, T. R., Hait, W. N., Lozano, G., Maris, J. M., Nelson, W. G., et al. (2012) · Clinical Cancer Research · doi:10.1158/1078-0432.ccr-12-2891 · Cited by 32
“However, tens of millions of Americans visit tanning salons each year (28).”
Background
Metadata
- Authors
- Lazovich, D., Vogel, R. I., Berwick, M., Weinstock, M. A., Anderson, K. E., & Warshaw, E. M.
- Affiliations
- University of Minnesota (US)
- Corresponding author
- Lazovich, DeAnn
- ORCID
- Venue
- Cancer Epidemiology, Biomarkers & Prevention
- Published
- 2010-06-01
- Volume
- 19
- Issue
- 6
- Pages
- 1557-1568
- ISSN
- 1055-9965 (ISSN-L)
- 1538-7755
- PMC
- PMC2883000
- OpenAlex
- W2097779490
- Cited by
- 353
- References
- 60
- Citations by year
- 2026: 3 · 2025: 8 · 2024: 3 · 2023: 3 · 2022: 13 · 2021: 13 · 2020: 15 · 2019: 15 · 2018: 21 · 2017: 30 · 2016: 28 · 2015: 21 · 2014: 33 · 2013: 42 · 2012: 40
- FWCI
- 23.21
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Cancer Epidemiology Biomarkers & Prevention (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Cancer Institute (R01CA106807)
- Topics
- Health Sciences › Medicine › Oncology › Cutaneous Melanoma Detection and Management
- Health Sciences › Medicine › Dermatology › Skin Protection and Aging
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › melanin and skin pigmentation
- Keywords
- indoor tanning, melanoma, tanning beds, dose-response relationship, sun exposure, melanoma risk factors
- MeSH terms
- Adult, Beauty Culture, Female, Humans, Male, Melanoma, Middle Aged, Minnesota, Surveys and Questionnaires, Risk Factors, Skin, Skin Neoplasms, Ultraviolet Rays, Case-Control Studies
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