Should tanning beds have cancer warnings like cigarettes?

By Stephen Beech

Tanning beds triple the risk of the deadliest form of skin cancer, warns new research.

The study is the first to show how solariums mutate skin cells far beyond the reach of ordinary sunlight.

Using sunbeds can potentially cause broad DNA damage, according to the American research team.

They say tanning beds should carry warnings similar to those on cigarettes.

The research team analyzed thousands of medical records to compare rates of melanoma - the deadliest form of skin cancer - in sunbed users to those who never use them.

They also sequenced over 180 skin biopsies from tanning bed users and non-users.

The findings, published in the journal Science Advances, showed that tanning bed users carried double the number of skin mutations compared to those who have never used them.

In users, mutations appeared even in body areas that don’t get much sun exposure

The study is the first time scientists have shown how sunbeds cause melanoma-linked DNA damage across nearly the entire skin surface.

This new study “irrefutably” proves tanning beds mutate skin cells far beyond the reach of ordinary sunlight, according to the researchers.

Study first author Professor Pedram Gerami, of Northwestern University Feinberg School of Medicine, Illinois, said: “Even in normal skin from indoor tanning patients, areas where there are no moles, we found DNA changes that are precursor mutations that predispose to melanoma.

“That has never been shown before.”

Gerami, who has been treating melanoma patients for 20 years, noticed an unusually high number of women under 50 with a history of multiple melanomas.

He suspected the linking factor was tanning beds.

Gerami designed the epidemiologic part of the study and compared the medical records of around 3,000 tanning bed users with 3,000 age-matched controls with no history of indoor tanning.

The team found that melanoma was diagnosed in 5.1% of tanning bed users compared with 2.1% of non-users.

After adjusting for age, sex, sunburn history and family history, tanning bed use remained associated with a 2.85-fold increase in melanoma risk.

Tanning bed users were also more likely to develop melanoma on usually sun-shielded areas of the body, such as the lower back and buttocks.

The findings supported the idea that tanning beds may cause broader DNA injury than sun exposure.

To test that hypothesis, the research team used new genomic technologies to perform single-cell DNA sequencing on melanocytes - the pigment-producing skin cells where melanoma begins - from three skin donor groups.

The first group included 11 of Gerami's patients with long histories of indoor tanning.

The second group consisted of nine patients who had never used tanning beds but were otherwise matched for age, sex and cancer risk profiles.

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A third group of six cadaver donors, who consented before death to donate their bodies for medical education, for additional skin tissue to round out the control samples.

The scientists sequenced 182 individual melanocytes and found skin cells from tanning bed users carried nearly twice as many mutations as those from controls and were more likely to contain melanoma-linked mutations.

Among indoor tanners, the mutations also appeared in body areas that usually remain protected from the sun, confirming that tanning beds create a broader field of DNA injury.

Gerami said: “In outdoor sun exposure, maybe 20% of your skin gets the most damage.

“In tanning bed users, we saw those same dangerous mutations across almost the entire skin surface.”

He said the study would not have been possible without the generosity of patients who donated their biopsies.

One of them, 49-year-old Heidi Tarr from the Chicago area, used tanning beds two or three times a week during high school because friends and celebrities at the time were also doing it.

She said “it felt like that's what made you beautiful.”

Decades later, as a mother in her thirties, she noticed a mole on her back and immediately feared the worst.

Her melanoma diagnosis led to surgery, years of frequent follow-up visits and more than 15 additional biopsies as new moles appeared.

Heidi said: “The biopsies can be painful, but the mental anxiety is worse.

“You’re always waiting for the call that it’s melanoma again.”

When Gerami explained the study, she volunteered more biopsies without hesitation.

Heidi said: “I value science, and I wanted to help.

“If what happened to my skin can help others understand the real risks of tanning beds, then it matters.”

After seeing the biological and clinical evidence, Gerami says the need for policy change is clear.

He said: “At the very least, indoor tanning should be illegal for minors.

“Most of my patients started tanning when they were young, vulnerable and didn’t have the same level of knowledge and education they have as adults.

“They feel wronged by the industry and regret the mistakes of their youth.”

Gerami says tanning beds should carry warnings similar to those on cigarettes.

He added: “When you buy a pack of cigarettes, it says this may result in lung cancer.

“We should have a similar campaign with tanning bed usage.

"The World Health Organisation has deemed tanning beds to be the same level of carcinogen as smoking and asbestos. It’s a class one carcinogen.”

Gerami says that anyone who frequently used tanning beds earlier in life should have a total-body skin examination by a dermatologist.