Perceptions of Tanning Risk Among Melanoma Patients With a History of Indoor Tanning
A new US Food and Drug Administration (FDA) regulation classified tanning beds as class II, requiring indoor tanning facilities to inform users of the risk of skin cancer in efforts to reverse the growing trend in indoor tanning. However, little is known from the patient’s perspective on whether knowledge of the risk of skin cancer development is a deterrent to indoor tanning. There also is conflicting literature regarding the relationship among frequency of indoor tanning, age at onset of melanoma diagnosis, and characteristics of diagnosis in melanoma patients with a history of indoor tanning. An international survey was conducted in patients 18 years and older who self-reported being diagnosed with melanoma after indoor tanning. The purpose of this study was to investigate the patients’ perspective on indoor-tanning behaviors as associated with the severity of their melanomas and the time frame in which they were diagnosed as well as their perceived views on the safety of indoor tanning and the frequency in which they continue to tan indoors.
Practice Points
- Despite US Food and Drug Administration reclassification and publicity of the risks of skin cancer, many patients continue to use sunbeds.
- It is important to assess how patients are obtaining information regarding sunbed safety, as indoor tanning companies are promoting sunbeds as “safe” tans.
- The increased combination of sunbed use and outdoor tanning is putting people at greater risk for the development of melanoma and nonmelanoma skin cancer.
Results
Of the 454 participants who accessed the survey, 448 were analyzed in this study; 6 participants did not complete the questionnaire. Both males and females were analyzed: 289 females, 12 males, and 153 who did not report gender. The age range of participants was 18 to 69 years. The age at start of indoor tanning ranged from 8 to 54 years, with a mean of 22 years. Additional participant characteristics are described in Table 1. The mean frequency of indoor tanning was reported as 2 times weekly. When participants were asked if they were warned of the risk of skin cancer, 21.5% reported yes while 78.4% reported not being told of the risk. This knowledge was compared to their frequency of indoor tanning. Having the knowledge of the risk of skin cancer had no influence on their frequency of indoor tanning (Table 2).
Among responders, those who perceived indoor tanning as safer than outdoor tanning tanned indoors more frequently than those who do not (Spearman r=−0.224; P<.05)(Table 3). The frequency of indoor tanning was divided into those who tanned indoors more than once weekly and those who tanned indoors once a week or less. This study showed that the frequency of indoor tanning had no effect on the latency time between the commencement of indoor tanning and diagnosis of melanoma (Table 4). The time frame from the onset of melanoma diagnosis also was compared to the age at which the participants started to tan indoors. Age was divided into those younger than 35 years and those 35 years and older. There was no correlation between the age when indoor tanning began and the time frame in which the melanoma was diagnosed (eTable).
Table 5 shows the correlations between indoor tanning behaviors and melanoma characteristics. Those who started indoor tanning at an earlier age were diagnosed with melanoma at an earlier age compared to those who started indoor tanning later in life (r=0.549; P<.01). Moreover, those who started indoor tanning at a later age reported being diagnosed with a melanoma of greater Breslow depth (r=0.173; P<.01). Those who reported being diagnosed with a greater Breslow depth also reported a higher Clark level (r=0.608; P<.01). Among responders, those who more frequently tanned indoors also reported greater frequency of outdoor tanning (r=0.197; P<.01). This study showed no correlation between the age at melanoma diagnosis and the frequency of indoor (r=0.004; P>.05 not significant) or outdoor (r=0.093; P>.05 not significant) tanning. Having the knowledge of the risk of skin cancer had no relationship on the frequency of indoor tanning (r=−0.04; P>.05 not significant).
