DERMATOLOGY IN THE NEWS:
Indoor Tanning, Melanoma and Acne
Dermatologist at Robert Wood Johnson Medical School
Background: NJ Governor Christie in 2013 signed a bill into law that prohibits children under 17 from using tanning beds and children under 14 using tanning sprays. He cited "the documented and well-understood risks associated with the misuse of indoor tanning".
What exactly are the risks that children in particular and people in general face from indoor tanning?
Indoor tanning has been proven to be a major risk factor for development of the three most common skin cancers: squamous cell carcinoma, basal cell carcinoma and melanoma. This is important because the rate of skin cancer has been rising for the past 30 years. An estimated 3.5 million cases of basal and squamous cell cancer occur in the United States annually. About 10,000 Americans are expected to die of melanoma in 2013. In 2009, the World Health Organization classified tanning devices as class I carcinogens based on their link to skin cancer.
Childhood sunburn is an important risk factor for melanoma and may increase risk by nearly 2-fold. Youth indoor tanning is an increasingly important risk factor for melanoma and may increase risk by 75%. Indoor tanning use may be responsible for 25% of melanomas. In addition to the important risk of skin cancer, tanning also leads to skin damage (called photoaging or photodamage) including wrinkles and dark spots, that are cosmetically concerning.
Are there any benefits to indoor tanning?
Some people believe tanning beds are harmless, but they expose you to the same dangerous UV radiation as sunlight. There are no benefits to indoor tanning. Contrary to popular belief, indoor tanning does not provide a protective effect prior to sun exposure.
We've read that sunlight is important for avoiding vitamin D deficiency. If so, wouldn't indoor tanning provide the same benefit?
Indoor tanning is not recommended as a way to achieve optimal vitamin D levels in the general public. Indoor tanning is proven to increase the risk of skin cancer. This risk surmounts any possible benefit, including potential increase in serum vitamin D levels, associated with indoor tanning. Furthermore, UVA-emitting tanning devices are relatively inefficient at increasing serum vitamin D levels. Finally, sufficient vitamin D levels can be established with a healthy diet or oral supplements, both of which do not carry an increased risk of skin cancer. Vitamin D obtained from diet or supplement can fully substitute for vitamin D synthesized in the skin. The American Academy of Dermatology recommends a daily total dose of 1000 IU of vitamin D for those at risk of vitamin D insufﬁciency or those who regularly and properly practice photoprotection.
Can you explain a little about the science of how the sun or a tanning lamp affects our skin?
Tanning, both through lamps indoors and sun outdoors, involves exposure to ultraviolet radiation. Ultraviolet radiation leads to changes in the genetic material of exposed skin cells. These changes, which are called mutations, increase the risk of the cells growing uncontrollably and developing into cancer. UV radiation is therefore a major risk factor for skin cancer, which means that tanning is a major risk factor for skin cancer. Ultraviolet radiation consists of three wavelength ranges: A, B and C. UVA rays cause cells to age, cause damage to cells’ genetic material, and play a role in the development of wrinkles and some skin cancers. UVB rays cause direct damage to DNA, sunburns and most skin cancers. UVC rays do not get through our atmosphere.
What do the numbers of SPF actually mean? Do products labeled as SPF 75 provide the same protection regardless of which company produces it?
The abbreviation SPF stands for Sun Protection Factor. The number of SPF reflects the delay in time to sunburn for a person wearing sunscreen compared to a person without sunscreen. The longer it takes to get sunburn while wearing sunscreen, the higher the SPF number. All products that are approved by the FDA should provide the same protection regardless of brand name. Sunscreen with “broad spectrum” protection (against UVA and UVB) and SPF of 30 or higher are recommended. Sunscreen should always be used because UV exposure occurs even on cloudy days. Reapply sunscreen every 2 hours and after swimming or sweating.
The best way to lower your risk of skin cancer is to protect yourself from exposure to UV radiation. Avoid being outdoors in the middle of the day between 10 am and 4 PM when UV light is strongest. When outdoors, protect your skin by wearing protective clothing and seek out shady areas.
Background: The New York Times recently reported on a study in which two drugs shrank tumors in about 41 percent of patients with advanced melanoma.
Is a cure in sight for melanoma?
New medications are being developed for the treatment of melanoma. The ability to cure melanoma depends on the stage at which it is diagnosed.
What approaches are researchers taking in developing drugs to combat melanoma?
Treatment of melanoma may include surgery, chemotherapy, radiation therapy, and other treatments. Exciting new drugs that are being developed to combat melanoma are called “targeted therapy” and “immunotherapy.” Target therapy attacks a specific activity that occurs in the tumor cells and supports their growth and survival; therefore the medications stop tumor growth and cause tumor cells to die. Immunotherapy activates the patient’s immune system to attack the cancer cells.
What are the early signs of melanoma? What should we look for?
Most melanomas develop from normal appearing skin but some arise from an
existing mole. It is important to be aware of all the spots on your body and to watch them to see if they are changing. If you find a new, unusual or changing spot on your body, it should be checked by a doctor.
Skin Spots: The ABC’s of Melanoma Detection
A for Asymmetry--one half is different from the other
B for Borders—spots has irregular and poorly defined borders
C for Color-- spots has different shades of brown or variety of colors (red, black, white, brown)
D for Diameter-- spot has greater than 6mm (approximately the size of a pencil eraser)
E for Evolving – the spot is changing in size, shape or color
Other warning signs: a sore that does not heal, spread of pigment from the border of a spot to the surrounding skin, redness or swelling beyond the border of a spot, sensation (itchiness, tenderness, pain), change in surface of a spot (scaling, oozing, bleeding)
Any spot on your body with the characteristics mentioned above may be worrisome for melanoma and should be examined by a physician.
How aware is the general population about melanoma?
Efforts to increase awareness of melanoma have led to improved early detection of this deadly cancer. Unfortunately, many people are still unaware of the importance of sun protection, skin self-examination and early detection of melanoma, so there is still work to be done. Teach your friends and family about the importance of sun avoidance, wearing sunscreen and doing self skin examinations!
Background: The journal Pediatrics has published new treatment guidelines for children with acne between the ages 7 - 12.
How common is acne in seven year olds? Isn’t just a teenage problem?
Acne is most common in teenage years, but can also occur in children. The prevalence of acne is reported to be 70-87% in teenagers, but has also been reported in 78% of girls ages 9-10. Acne is not uncommon in preadolescents as a result of hormonal maturation and may be the first sign of puberty. Acne that occurs in children between ages 1 and 7 is considered rare and should prompt a visit to a doctor and work up for a hormonal abnormality. Spots that look like pimples, but are due to a condition other than acne, may occur in babies and young children.
How do treatments for young children with acne differ from treatments for teenage or adults?
Treatment of acne in young children is difficult because the majority of clinical trials for acne medications are conducted in patients 12 and older, which means there is little published research on efficacy and safety of acne medications in young children. Recently pediatric experts developed guidelines for treating pediatric acne. Treatment of mid-childhood acne (ages 1-7) is similar to that of adolescent except oral tetracyclines (antibiotics) are avoided due risk of damage to developing bones and teeth. Treatment of preadolescent and adolescent acne is similar and includes benzoyl peroxide, topical retinoids, topical antibiotics, oral antibiotics, and oral isotretinoin depending on severity.
Is this a downward shift a sign that our children in general are reaching puberty earlier than before?
Acne may be the first sign of pubertal maturation. With the trend towards earlier age of onset of puberty there is a downward shift in the age that acne first appears. Earlier onset of acne may be a consequence of early pubertal maturation.
Dr. Cha is an Assistant Professor, Department of Dermatology at Rutgers University; she is a dermatologist and dermatopathologist. She is the Associate Program Director for the Dermatology residency program at Rutgers University. Contact: Jisun Cha MD, FAAD. email@example.com
American Cancer Society. Melanoma Skin Cancer Overview. Accessed at http://www.cancer.org/cancer/skincancer-melanoma/overviewguide/index on 1 June 2013.
Townsend JS, Pinkerton B, McKenna SA, Higgins SM, Tai E, Steele CB, Derrick SR, Brown C. Targeting children through school-based education and policy strategies: comprehensive cancer control activities in melanoma prevention. J Am Acad Dermatol. 2011; 65(5 Suppl 1):S104-13.
Watson M, Holman DM, Fox KA, Guy GP, Seidenberg AB, Sampson BP, Sinclair C, Lazovich D. Preventing skin cancer through reduction of indoor tanning: current evidence. Am J Prev Med. 2013; 44(6):682-9.
International Agency for Research on Cancer Working Group on artificial ultraviolet (UV) light and skin cancer. The International Agency for research on cancer Working Group on artificial ultraviolet (UV) light and skin cancer: The association of use of sunbeds with cutaneous malignant melanoma and other skin cancers: A systematic review. Int J Cancer. 2007; 120(5):1116-1122.
Questions and Answers: FDA announces new requirements for over-the-counter (OTC) sunscreen products marketed in the U.S. Accessed at http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/UnderstandingOver-the-CounterMedicines/ucm258468.htm on June 1 2013.
Miller DR, Geller AC, Wyatt SW, Halpern A, Howell JB, Cockerell C, Reilley BA, Bewerse BA, Rigel D, Rosenthal L, Amonette R, Sun T, Grossbart T, Lew RA, Koh HK. Melanoma awareness and self-examination practices: results of a United States survey. J Am Acad Dermatol. 1996; 34(6):962-70.
Eichenfield LF, Krakowski AC, Piggott C, Del Rosso J, Baldwin H, Friedlander SF, Levy M, Lucky A, Mancini AJ, Orlow SJ, Yan AC, Vaux KK, Webster G, Zaenglein AL, Thiboutot DM. Evidence-based recommendations for the diagnosis and treatment of pediatric acne. Pediatrics. 2013; 131 Suppl 3:S163-86.
Lucky AW, Biro FM, Huster GA, Leach AD, Morrison JA, Ratterman J. Acne vulgaris in premenarchal girls. An early sign of puberty associated with rising levels of dehydroepiandrosterone. Arch Dermatol.1994;130(3):308–314
Lucky AW, Biro FM, Huster GA, Morrison JA, Elder N. Acne vulgaris in early adolescent boys. Correlations with pubertal maturation and age. Arch Dermatol. 1991; 127(2):210-6.
Wook DK, Eide MJ. Tanning beds, skin cancer and vitamin D: an examination of the scientific evidence and public health implication. Dermatologic Therapy. 2010;23:61-71.
Gilchrest BA. Sun protection and Vitamin D: Three dimensions of obfuscation. The Journal of Steroid Biochemistry and Molecular Biology. 2007;10393-5:655-663.
Learn More @ Robert Wood Johnson Library of the Health Sciences
- Fitzpatrick's Dermatology in General Medicine, 2012 (AccessMedicine)
- Fitzpatrick's Color Atlas and Synopsis of Clinical Dermatology, 2009 (AccessMedicine)
- Clinical Dermatology: a Color Guide to Diagnosis and Therapy, 2009 (MD Consult)
- Sauer's Manual of Skin Diseases, 2006 (Books@OVID)
- Lever's Histopathology of the Skin, 2005 (Books@Ovid)
- Journal of Investigative Dermatology
- British Journal of Dermatology
- Journal of American Academy of Dermatology