Indoor Tanning and the Risk of Overall and Early-Onset Melanoma and Non-Melanoma Skin Cancer: Systematic Review and Meta-Analysis

An, Seokyung; Kim, Kyungsik; Moon, Sungji; Ko, Kwang-Pil; Kim, Inah; Lee, Jung Eun; Park, Sung Sup

doi:10.3390/cancers13235940

Cited by 24 publications

(32 citation statements)

References 45 publications

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“…Several systematic reviews and meta-analyses have consistently established a statistically significant higher risk of cutaneous melanoma with the use of sunbeds (summarized in Table 2 ) [ 18 , 37 , 38 , 39 , 40 , 41 , 42 ]. Nevertheless, the quantification of the measure of the association of sunbed use with melanoma risk is hindered by limitations inherent to the design of individual studies.…”

Section: Sunbed Use and Risk Of Cutaneous Melanomamentioning

confidence: 99%

“…Nevertheless, the quantification of the measure of the association of sunbed use with melanoma risk is hindered by limitations inherent to the design of individual studies. The most recent meta-analysis of An et al (2021), included 36 studies in 14,583 melanoma cases and reported that the risk of cutaneous melanoma increased by 27% for those ever exposed to indoor tanning (RR: 1.27, 95% CI: 1.16–1.39) [ 37 ]. Similar risk estimates have been reported in previous meta-analyses (RR ranging from 1.15 to 1.27) ( Table 2 ).…”

Section: Sunbed Use and Risk Of Cutaneous Melanomamentioning

confidence: 99%

“…A dose-response relationship has been consistently shown between the amount of sunbed use and the risk of melanoma ( Table 2 ). A significantly higher risk of melanoma was associated with 10 or more annual times of sunbed use [ 37 , 38 , 39 ] and with high [ 18 ] or longest exposure [ 42 ]. The meta-analysis of Boniol et al (2012) reported a 1.8% increase in risk of melanoma for each additional session of indoor tanning per year [ 18 ].…”

Section: Sunbed Use and Risk Of Cutaneous Melanomamentioning

confidence: 99%

“…The younger age at first exposure to sunbeds has been associated with significantly higher risk of melanoma in individual studies [ 44 , 45 , 46 , 47 , 48 ], systematic reviews and meta-analyses [ 18 , 37 , 41 , 49 ] ( Table 2 ). The study of Lazovich et al, was the first to investigate age-specific and sex-specific associations between indoor tanning and melanoma and suggested that sunbed use may be contributing to the steeper increase in melanoma rates in younger women [ 44 ].…”

Section: Sunbed Use and Risk Of Cutaneous Melanomamentioning

confidence: 99%

“…In the meta-analysis of Boniol et al (2012), there was a 1.59-fold higher risk of cutaneous melanoma for those that first used sunbeds at an age younger than 35 [ 18 ]. In the meta-analysis of An et al (2021), exposure to indoor tanning before the age of 20 was associated with 1.47-fold higher risk for cutaneous melanoma (95% CI: 1.16–1.85) [ 37 ]. On the other hand, the meta-analysis of Colantonio et al reported a higher, but not statistically significant, risk for those younger than 25.…”

Section: Sunbed Use and Risk Of Cutaneous Melanomamentioning

confidence: 99%

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An Epidemiological Update on Indoor Tanning and the Risk of Skin Cancers

Dessinioti

Stratigos

2022

Current Oncology

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Indoor tanning (sunbeds, solarium) uses artificial ultraviolet radiation (UVR) to stimulate cosmetic tanning of the skin. Indoor tanning has been officially classified as a human carcinogen in 2009 by the International Agency for Research on Cancer of the World Health Organization (WHO). The differences in the prevalence of sunbed use across countries and over the years highlight underlying legislative, climatic, and cultural differences. Indoor tanning-seeking behaviors may be driven by motivations for an appealing appearance, largely influenced by gender and age, and several misconceptions that a prevacation tan safeguards the skin, that sunbeds can be used to treat acne or to increase vitamin D, or that tanning is a healthy habit. This review provides an epidemiological update on the prevalence of sunbed use, who tends to use sunbeds and why, and details the current evidence on the association of sunbeds with skin cancers, including cutaneous melanoma, basal cell carcinoma (BCC), and cutaneous squamous cell carcinoma (cSCC). Α statistically significant higher risk of cutaneous melanoma, BCC and cSCC with the use of sunbeds has been consistently demonstrated. This risk of skin cancer is even higher with the more frequent use of sunbeds, underscoring a dose–response relationship, and in those first exposed to sunbeds at a younger age. Preventive measures against sunbed use include legislation restricting sunbed use, educational campaigns to inform and discourage from indoor tanning, as well as using the internet, online advertising messages and the social media to reach larger audiences and to promote an untanned appearance.

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Section: Sunbed Use and Risk Of Cutaneous Melanomamentioning

confidence: 99%

Section: Sunbed Use and Risk Of Cutaneous Melanomamentioning

confidence: 99%

Section: Sunbed Use and Risk Of Cutaneous Melanomamentioning

confidence: 99%

Section: Sunbed Use and Risk Of Cutaneous Melanomamentioning

confidence: 99%

Section: Sunbed Use and Risk Of Cutaneous Melanomamentioning

confidence: 99%

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An Epidemiological Update on Indoor Tanning and the Risk of Skin Cancers

Dessinioti

Stratigos

2022

Current Oncology

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Melanoma Incidence by Sex, Indoor Tanning, and Body Site—Reply

Adamson

Welch

2023

JAMA Intern Med

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COMMENT & RESPONSEIn Reply We appreciate the tremendous enthusiasm with which Drs He and Huang read our article 1 highlighting the weak association between proxies for UV radiation exposure and melanoma incidence across US counties. Although this revelation may be surprising to some readers and could shatter longstanding perceptions for others, it is not a new finding. The metaanalytic relative risk for the strongest UV-related risk factorsunburn history-is only 2.0. 2 This relatively weak association is not recognized by the wider public because sun exposure and its association with melanoma are too often (and inappropriately) compared with smoking and lung cancer (relative risk, 10.0-20.0). Although UV radiation exposure may be a modifiable risk factor for melanoma, it is certainly not formidable.Drs He and Huang posit 3 factors-biological sex, tanning, and body site-that may obscure the association of UV radiation exposure with melanoma. They point out that there are some studies demonstrating an association among male individuals but not among female individuals. Nevertheless, there are other studies demonstrating equally strong associations by sex. 3 Although it is difficult to imagine a biologic explanation for why UV radiation exposure is more substantial among men than women, it is easy to postulate why the association would be more evident in men: women are more likely to be overdiagnosed by greater diagnostic scrutiny. 4 Overdiagnosis can obscure genuine risk factors. For example, after chest computed tomography screening of the general population, Japanese investigators reported similar rates of lung cancer detection among smokers as nonsmokers. 5 Tanning bed use is even more weakly associated with melanoma than is sunburn history. The meta-analysis 6 cited by Drs He and Huang reported a summary relative risk of approximately 1.27 for the association between tanning bed use and melanoma. Even if indoor tanning use was ubiquitous in some counties (and unheard of in others), this exposure could not explain the up to 10-fold differences in incidence rates across US county populations.The body site on which melanoma develops may be affected by the type of UV radiation. For example, head and neck melanoma is more closely associated with long-term UV radiation exposure, while truncal melanoma is more strongly associated with intermittent exposure. Our study 1 captured proxies for each of these types of UV radiation exposure. Future work could focus on how each proxy may affect mela-

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Melanoma Incidence by Sex, Indoor Tanning, and Body Site

Huang

2023

JAMA Intern Med

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To the Editor We read with tremendous enthusiasm the original investigation by Dr Adamson and colleagues 1 demonstrating the prominence of high diagnostic scrutiny in melanoma incidence and the necessity to take seriously the role it plays in melanoma mortality. What intrigued us is the study's conclusion that UV radiation exposure has a weak association with melanoma incidence in the US, shattering the long-standing perception of UV radiation as a formidable risk factor. If the conclusion holds true, it will alleviate the unease to some extent and downsize the magnitude of risk factors, among which UV radiation has been the most widely accepted and biggest culprit for melanoma.The study by Dr Adamson and colleagues 1 was extensively controlled for important confounders, including age, UV radiation proxies, and diagnostic scrutiny proxies. However, we believe there are 3 confounders that should be highlighted by this outstanding original investigation. First, the difference by sex should be addressed. A large observational study 2 that collected data on melanoma from 31 international cancer registries and cross-validated these global data against a second data set from 42 US states showed that melanoma incidence among male individuals was significantly associated with UV radiation exposure, but among female individuals, it was not. The significant association in men and the nonassociation in women were validated among a US population of White individuals. Furthermore, the high incidence of melanoma among men has been validated by another retrospective cohort study of 265 302 cases of melanoma. 3 The second confounder that should be highlighted is indoor tanning. In the setting of high rates of indoor tanning use among young White (not Hispanic) individuals, a systematic review and meta-analysis 4 found a significant association between indoor tanning and a higher risk of melanoma.Indoor tanning may be a potential risk factor when 2 areas are at opposite extremes of UV radiation exposure, yet incidence is at similar levels.The third confounder is the body site on which the melanoma occurs. A large, population-based, prospective cohort study of 161 540 individuals 5 found a significant association of UV radiation exposure or indoor tanning and melanoma on the lower extremities.We regard the findings of Dr Adamson and colleagues 1 to be groundbreaking. However, if the confounders that we enumerated were to supplement this investigation, its findings would be more targeted and more useful to researchers designing randomized clinical trials and to public health officials developing relevant health policies.

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Indoor Tanning and the Risk of Overall and Early-Onset Melanoma and Non-Melanoma Skin Cancer: Systematic Review and Meta-Analysis

Cited by 24 publications

References 45 publications

An Epidemiological Update on Indoor Tanning and the Risk of Skin Cancers

An Epidemiological Update on Indoor Tanning and the Risk of Skin Cancers

Melanoma Incidence by Sex, Indoor Tanning, and Body Site—Reply

Melanoma Incidence by Sex, Indoor Tanning, and Body Site

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