“If only we had the knowledge these young people have today, we wouldn’t have all this sun damage,” an elderly couple chimed as I reiterated the use of sunscreen. “We fried ourselves with oil and iodine.”
By Emily Jorge, DCNP, FNP-BC
“Ignorance is bliss, knowledge is power.” This adage most likely adapted by the 18th-century English poet Thomas Gray has left many who see a dermatologist skeptical as they hear the words, “You have skin cancer.” They recall their wonderful summer afternoons tanning long ago—J’avais l’habitude de bronzer nu, my French patient might add—and wish for younger days again to revise those moments. “If only we had the knowledge these young people have today, we wouldn’t have all this sun damage,” an elderly couple chimed as I reiterated the use of sunscreen. “We fried ourselves with oil and iodine.”
Do young people in the United States actually possess this information? Do healthcare providers share their knowledge with their younger patients on issues related to tanning, especially indoor tanning? This question prompted me to quickly review the literature, especially after I found a large melanoma on the arm of a 13-year-old girl recently.
A review of a recent article titled “Nurse Practitioners’ Knowledge of Prevention Guidelines and Counseling Practices Related to Primary Prevention of Skin Cancer Among Adolescents in Arizona” reveal the need for providers to educate this age group in performing self body exams and/or refer to a dermatologist for a full body exam. 
Let’s look at the highlights:
- Eighty percent of providers do not perform full body skin examinations, citing the main barrier as lack of time during an office visit.
- Most providers provide preventive counseling or skin cancer prevention education to their patients only sometimes or never.
Another journal review from the Journal of the American Academy of Dermatology (JAAD) entitled “The Potential Impact of Reducing Indoor Tanning on Melanoma Prevention and Treatment Costs in the United States: An Economic Analysis” revealed the following:
Restricting indoor tanning among minors younger than 18 years was estimated to prevent 61,839 melanoma cases, prevent 6,735 melanoma deaths, and save $342.9 million in treatment costs over the lifetime of the 61.2 youth, age 14 years or younger in the United States. The estimated health and economic benefits increased as indoor tanning was further reduced. 
Many young people still use a tanning bed. For these individuals the following reasons from the American Academy of Dermatology should prompt a full body examination and evaluation by a dermatologist:
- Higher melanoma rates among young females compared to young males may be due in part to widespread use of indoor tanning among females.
- Using indoor tanning beds before age 35 can increase your risk of melanoma, the deadliest form of skin cancer, by 59 percent; the risk increases with each use.
- Women younger than 30 are six times more likely to develop melanoma if they tan indoors.
- Research demonstrates that even people who do not burn after indoor tanning or sun exposure are at an increased risk of melanoma if they tan indoors.
- Even one indoor session can increase users’ risk of developing squamous cell carcinoma by 67 percent and basal cell carcinoma by 29 percent.
- Indoor tanning before age 24 increases one’s risk of developing basal cell carcinoma by age 50. 
Legislation and Regulation Highlights
- In May 2014, the U.S. Food and Drug Administration issued new regulations strengthening warnings for indoor tanning devices. These regulations include:
- A strong recommendation against the use of tanning beds by minors under 18.
- The reclassification of tanning beds and sunlamps from Class I to a Class II medical devices, which means they are considered “moderate to high risk.” The FDA mandates additional oversight of Class II devices, requiring manufacturers to provide more safety assurances.
- Labeling that:
- Clearly informs users about the risks of using tanning beds.
- Warns frequent users of sunlamps to be regularly screened for skin cancer.
- Alerts users that tanning lamps are not recommended for people under 18 years old.
- In December 2015, the FDA proposed an age restriction on indoor tanning for minors under the age of 18, as well as a risk acknowledgement form that all adults must sign before using indoor tanning devices.
- California, Delaware, the District of Columbia, Hawaii, Illinois, Louisiana, Minnesota, Nevada, New Hampshire, North Carolina, Texas, and Vermont have passed laws that prohibit minors under the age of 18 from indoor tanning.
- Oregon and Washington have passed laws prohibiting minors under the age of 18 years old from using indoor tanning devices, unless a prescription is provided.
- Connecticut, New Jersey, New York and Pennsylvania have passed legislation banning minors under the age of 17 from using tanning devices.
Make it a point this spring to check your adolescent’s skin and schedule an appointment today with one of our providers!
- Lucas, Maxine A., Loescher, Lois J., & Pacheco, Christy L. (2016). “Nurse Practitioners’ Knowledge of Prevention Guidelines and Counseling Practices Related to Primary Prevention of Skin Cancer Among Adolescents in Arizona.” Journal of the Dermatology Nurses’ Association, 8(6), 368-379.
- Guy Gery P., Zhang, Y., Ekwueme, Donatus U., Rim, Sun H. & Waston, M. (2017). “The Potential Impact of Reducing Indoor Tanning on Melanoma Prevention and Treatment Costs in the United States: An Economic Analysis.” Journal of the American Academy of Dermatology, 76(2), 226-233. Retrieved March 19,2017 from jaad.org/article/S0190-9622(16)30871-4/abstract
- American Academy of Dermatology (2016). Indoor Tanning. Retrieved December 2016 from https://www.aad.org/media/stats/prevention-and-care