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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]
Experimental — accuracy not yet measuredIn the citing paper
“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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Vogel, R. I., Strayer, L., Ahmed, R. L., Blaes, A. H., & Lazovich, D. (2017) · Journal of Skin Cancer · doi:10.1155/2017/2041872 · Cited by 32
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MethodInfluentialSelf-citationFerrucci, L. M., Vogel, R. I., Cartmel, B., Lazovich, D., & Mayne, S. T. (2014) · Journal of the American Academy of Dermatology · doi:10.1016/j.jaad.2014.06.046 · Cited by 31
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Self-citationSex differences in rising trends of cutaneous malignant melanoma in Norway, 1954–2008
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“Exposure to artificial UVR increases the risk of skin cancer, irrespective of age of initial indoor tanning [7,45].”
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“Research has shown there is widespread non-compliance with regulations with regard to posting appropriate warning signs, obtaining users’ informed consent, restrictions of users with respect to their age and skin-type, restrictions of the frequency of sessions, the intensity of UV radiation (UVR)used and the failure o…”
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“In conclusion, a situation has arisen in Australia where solarium users have access to high speed ⁄ high intensity sunbeds, which new evidence (28,29) has now linked to significant increases in melanoma in comparison with nonusers.”
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Self-citationVitamin D, sun, sunbeds and health
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“Our inability to recapitulate these findings in this study is likely a combination of (1) low sample size, given that only 9 individuals reported using tanning beds >100 times in their lifetimes, (2) heterogeneity in the dose and spectral characteristics of tanning bed UV radiation, [46] and (3) our inability to speci…”
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“, 2008), delivered by sunlight and indoor tanning devices (Armstrong and Kricker, 2001; Boniol et al., 2012; El Ghissassi et al., 2009; Lazovich et al., 2010; Wehner et al., 2012).”
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“Extensive studies have linked CMM risks to sunlight exposure-related behaviours, such as strong sun exposure in childhood [17,18], sunburn episodes [19,20], solarium use [21–23], and outdoor work [24].”
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“Further evidence was provided by a case-control study that showed a 74% increased risk of melanoma among tanning bed users no matter when they began tanning.(37) In 2009, the CDC added a question on indoor tanning use to its Youth Risk Behavior Survey.”
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InfluentialErythema and ultraviolet indoor tanning: findings from a diary study
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Indoor Tanning and Risk of Melanoma: A Case-Control Study in a Highly Exposed Population
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Friendly tanning: young adults’ engagement with friends around indoor tanning
Rodríguez, V. M., Daniel, C. L., Welles, B. F., Geller, A. C., & Hay, J. L. (2017) · Journal of Behavioral Medicine · doi:10.1007/s10865-017-9832-4 · Cited by 12
“, 2012; International Agency for Research on Cancer Working Group on Artificial Ultraviolet Light and Skin Cancer, 2007), with an observed dose response (Lazovich et al., 2010).”
Prevalence and Correlates of Skin Cancer Screening Among Indoor Tanners and Nontanners
Heckman, C. J., Handorf, E. A., & Auerbach, M. V. (2018) · JAMA Dermatology · doi:10.1001/jamadermatol.2018.0163 · Cited by 12
“The millions of Americans who have tanned indoors are at much higher risk of melanoma and keratinocyte skin cancers thanthegeneralpopulation.(8,9)Owingtoaccumulatingevidence of the harms of indoor tanning, the US Food and Drug Administration(FDA)andsimilarbodies inothercountrieshave become increasingly stringentabout…”
Atypical moles: diagnosis and management.
Perkins, A., & Duffy, R. L. (2015) · PubMed · Cited by 12
Melanoma — Epidemiology, Genetics and Risk Factors
John, A., Jarrett, S. G., Marsch, A. F., Lagrew, J. P., & Cleary, L. C. (2013) · InTech eBooks · doi:10.5772/55172 · Cited by 16
“Risk of carcinogenesis is enhanced for all types of tanning beds (UVA, UVB and mixed output) and increases with years of use, number of sessions, and hours exposed (Lazovich et al., 2010).”
BackgroundMakin, J. K., Hearne, K., & Dobbinson, S. J. (2011) · Photodermatology Photoimmunology & Photomedicine · doi:10.1111/j.1600-0781.2011.00613.x · Cited by 11
“Of the 30 operators, 43% were considered to be compliant on all key licence provisions as they (1) excluded the under age research assistant who was honest about her age; (2) excluded the research assistant with skin type 1; (3) conducted a skin type assessment; (4) had the research assistant complete a consent form;…”
BackgroundInfluentialAssessment of Compliance With Texas Legislation Banning Indoor UV Tanning by Minors
Tripp, M. K., Gershenwald, J. E., Davies, M. A., Garcia, J., Gritz, E. R., Hawk, E. T., & Peterson, S. K. (2016) · JAMA Dermatology · doi:10.1001/jamadermatol.2016.4068 · Cited by 11
“Tanning associate did not respond “yes” or “no” but implied it was possible to experience a burn from the tanning bed Depends on your skin type/whether you burn in the sun/type of bed/if you tan for too long 14 (2)”
Practices of Unregulated Tanning Facilities in Missouri: Implications for Statewide Legislation
Balaraman, B., Biesbroeck, L. K., Lickerman, S., Cornelius, L. A., & Jeffe, D. B. (2013) · PEDIATRICS · doi:10.1542/peds.2012-1781 · Cited by 11
Intentional tanning behaviors among undergraduates on the United States’ Gulf Coast
Daniel, C. L., Gassman, N. R., Fernandez, A. M., Bae, S., & Tan, M. C. B. (2018) · BMC Public Health · doi:10.1186/s12889-018-5345-5 · Cited by 11
Sun exposure and protection behaviors in urban and rural long-term melanoma survivors
Jewett, P. I., Lazovich, D., Wehelie, H., Boull, C. L., & Vogel, R. I. (2019) · Archives of Dermatological Research · doi:10.1007/s00403-019-02023-7 · Cited by 11
Self-citationCarcioppolo, N., Dunleavy, V. O., & Myrick, J. G. (2018) · Health Communication · doi:10.1080/10410236.2018.1517632 · Cited by 11
“One factor responsible for increased skin cancer incidence is indoor tanning, which increases risk of melanoma, the deadliest form of skin cancer, by 75% (Lazovich et al., 2010).”
BackgroundGupta, R. K., Parvadiya, L., & Dudhat, K. R. (2025) · Critical Reviews in Therapeutic Drug Carrier Systems · doi:10.1615/critrevtherdrugcarriersyst.2025053255 · Cited by 10
Investigating the role of implicit prototypes in the prototype willingness model
Howell, J. L., & Ratliff, K. A. (2016) · Journal of Behavioral Medicine · doi:10.1007/s10865-016-9814-y · Cited by 10
Association of Indoor Tanning Exposure With Age at Melanoma Diagnosis and BRAF V600E Mutations
Burbidge, T., Bastian, B. C., Guo, D., Li, H., Morris, D. G., Monzon, J. G., Leung, G., Yang, H., & Cheng, T. Q. (2019) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/djz048 · Cited by 10
Chaudhry, S. B., Armbrecht, E. S., Gibbons, M., Knutson, A. J., & Lickerman, S. (2021) · Dermatologic Surgery · doi:10.1097/dss.0000000000003093 · Cited by 10
Exposure 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/dju112 · Cited by 10
“Because indoor tanning–related burns are fairly common (10,11) and we wanted to examine whether moderate use of indoor tanning, evidenced by the absence of burning, is associated with melanoma, we excluded exposed persons who reported experiencing a burn while tanning indoors.”
BackgroundMethodInfluentialSelf-citationNovacescu, D., Cut, T. G., Cumpănaş, A. A., Bratosin, F., Ceauşu, R. A., & Raica, M. (2022) · Biomedicines · doi:10.3390/biomedicines10112673 · Cited by 10
“Conversely, despite causing melanoma in murine model exposure experiments [29], UVAs are less energetic and incapable of producing the cytosine-containing CPDs that lead to the characteristic C to T substitution, UV-signature mutations, frequently seen in human melanomas [51,52].”
BackgroundBroad-spectrum moisturizer effectively prevents molecular reactions to UVA radiation.
Seité, S., Reinhold, K., Jaenicke, T., Brenden, H., Krutmann, J., & Grether‐Beck, S. (2012) · PubMed · Cited by 10
Ultraviolet A Light: Potential Underlying Causes of Melanoma
Tang, M. (2010) · Future Oncology · doi:10.2217/fon.10.129 · Cited by 10
The Story Behind the Sharp Decline in US Tanning Bed Rates
Geller, A. C. (2018) · American Journal of Public Health · doi:10.2105/ajph.2018.304521 · Cited by 10
Tanning lamps: Health effects and reclassification by the Food and Drug Administration
Ernst, A., Grimm, A., & Lim, H. W. (2014) · Journal of the American Academy of Dermatology · doi:10.1016/j.jaad.2014.10.016 · Cited by 9
A Cross-Sectional Study of Indoor Tanning in Fitness Centres
Huang, C. M., & Kirchhof, M. G. (2017) · Journal of Cutaneous Medicine and Surgery · doi:10.1177/1203475417706059 · Cited by 9
UV Radiation and Skin Cancer: The Science behind Age Restrictions for Tanning Beds
Schmidt, C. W. (2012) · Environmental Health Perspectives · doi:10.1289/ehp.120-a308 · Cited by 9
“The researchers also revealed a strong dose–response relationship: Those who had tanned 10 or fewer times had a 34% higher risk of melanoma, and those who had tanned 100 times or more had a 272% higher risk, compared with those who had never tanned.(15) What Lazovich’s team didn’t f ind, how ever, was evidence that me…”
BackgroundResultShould we be targeting potential addictive behaviors in tanning bed users?
Adinoff, B. H. (2012) · Neuropsychiatry · doi:10.2217/npy.11.75 · Cited by 9
Indoor Tanning and the MC1R Genotype: Risk Prediction for Basal Cell Carcinoma Risk in Young People
Molinaro, A. M., Ferrucci, L. M., Cartmel, B., Loftfield, E., Leffell, D. J., Bale, A. E., & Mayne, S. T. (2015) · American Journal of Epidemiology · doi:10.1093/aje/kwu356 · Cited by 9
DNA repair variants, indoor tanning, and risk of melanoma
Torres, S. M., Luo, L., Lilyquist, J., Stidley, C. A., Flores, K., White, K. A., Erdei, E., Gonzales, M., Paine, S., Vogel, R. I., et al. (2013) · Pigment Cell & Melanoma Research · doi:10.1111/pcmr.12117 · Cited by 9
“Melanoma risk was noted in carriers of variants within XRCC3 (Figl et al., 2010); a similar association was found with SNPs within APEX1 (Li et al., 2006).”
BackgroundResultSelf-citationEffect of Legislation on Indoor Tanning Prevalence in Alabama
Blashill, A. J., & Pagoto, S. (2017) · American Journal of Public Health · doi:10.2105/ajph.2017.303716 · Cited by 9
Ferreira, T., Santos, I. D. D. A. O., de Oliveira, A. F., & Ferreira, L. M. (2018) · Revista do Colégio Brasileiro de Cirurgiões · doi:10.1590/0100-6991e-20181715 · Cited by 9
Kamath, S., Miller, K. A., & Cockburn, M. (2016) · Journal of Skin Cancer · doi:10.1155/2016/2105250 · Cited by 8
“[32] D.”
BackgroundAdolescent Indoor Tanning Use and Unhealthy Weight Control Behaviors
Amrock, S. M., & Weitzman, M. L. (2014) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0000000000000050 · Cited by 8
Cutaneous Melanoma: Sheep in Wolves Clothing?
de Gruijl, F. R., & Armstrong, B. K. (2022) · Anticancer Research · doi:10.21873/anticanres.16010 · Cited by 9
Tanning beds: A call to action for further educational and legislative efforts
Farley, C. R., Alimi, Y., Espinosa, L. R., Perez, S. D., Knechtle, W. S., Hestley, A. C., Carlson, G. W., Russell, M. C., Delman, K. A., & Rizzo, M. (2015) · Journal of Surgical Oncology · doi:10.1002/jso.23969 · Cited by 8
Produits de protection solaire : efficacité et risques
Béani, J.-C. (2012) · Annales de Dermatologie et de Vénéréologie · doi:10.1016/j.annder.2012.01.022 · Cited by 8
“[3] Lazovich D, Vogel RI, Berwick M, Weinstock MA, Anderson”
Public Health and the Tanning Bed Controversy
Brady, M. S. (2012) · Journal of Clinical Oncology · doi:10.1200/jco.2011.40.9359 · Cited by 8
Stemming the Tanning Bed Epidemic: Time for Action
Geller, A. C., Balk, S. J., & Fisher, D. E. (2012) · Journal of the National Comprehensive Cancer Network · doi:10.6004/jnccn.2012.0133 · Cited by 7
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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