July 2012

Dear colleague, Artificial tanning risks in young patients For years, tanning beds have been commonly accepted as being a relatively safe way to get a tan before a special event or holiday. They were thought to be associated with premature aging and solar keratoses, but not much else. What we now know, and the message that needs to get out to the public, is that tanning beds are associated with an increased risk of skin cancer. Indoor tanning is a risky behavior, with those who use tanning beds before the age of 35 increasing their risk of malignant melanoma by 75 per cent. In 2006, the World Health Organization recommended that tanning devices be considered on par with carcinogens such as tobacco and arsenic as a Group 1 human carcinogen and that they not be used by those under 18. Some of your patients are likely clients of tanning salons. Some points to help you with your preventive efforts. Tanning beds ARE NOT "natural". There is nothing natural about high voltage passed through high pressure mercury in a glass tube placed close to the skin. Some tanning beds may emit levels of radiation 10-15 times the intensity of midday Mediterranean sun. Tanned skin IS NOT healthy skin. Tanned skin is damaged skin. A tan is the skin`s attempt to protect itself from the environmental stress caused by UV light, and is triggered by UV-induced DNA mutations. Tanning beds DO NOT improve appearance. UV exposure causes premature skin aging and prolonged tanning will lead to sun spots, telangiectasia, wrinkles and leathery skin. Surgical removal of abnormal moles and skin cancers leaves scars. Pre-tanning in tanning beds DOES NOT provide good protection against sunburn. It is like a sunscreen with SPF of just 2-4. Instead, a sunscreen and a lip balm with a minimum SPF of 30 should be used. Tanning beds ARE NOT a good source of Vitamin D. Tanning beds emit mostly UVA radiation which does not produce vitamin D. Tanning beds ARE NOT a treatment for seasonal affective disorder (SAD). The treatment of SAD involves visible light, not the UV light found in tanning devices. A SAD light is less expensive than ongoing tanning sessions and more effective.

In some patients who use tanning beds frequently there is evidence of physiological and psychological addiction. Regular tanners, who make up about 25 per cent of all tanners, are most at risk, as they usually start the youngest and are often extremely tanned. This group should be screened for SAD and body image disorders, and treated appropriately if needed. Please counsel your patients against the use of artificial tanning, especially youths and young adults. The Indoor Tanning is Out coalition is advocating for strong legislation that will protect Albertas teenagers and young adults from the risks of artificial tanning. The coalition consists of a broad range of health experts from organizations including the Canadian Dermatology Association, Canadian Cancer Society, Alberta Society of Dermatologists, and the Alberta Public Health Association, among others. Alberta Health Services is also a member and supports the coalitions efforts to raise awareness and educate Albertans about the risks of artificial tanning. References and further information can be obtained by emailing Environmental Carcinogens Program Coordinator Patrick Curley (patrick.curley@albertahealthservices.ca). A patient guide to self examination for skin cancer is available by emailing Jennifer Scott at the Canadian Dermatology Association (jscott@dermatology.ca).

Christopher Sikora, MD MPH MSc CCFP FRCP(C) Lead Medical Officer of Health Edmonton Zone