Tanning salon exposure and molecular alterations

Signaling Pathways and Therapeutic Strategies in Advanced Basal Cell Carcinoma

Non-melanoma skin cancers (NMSCs) are the most common human neoplasms world-wide. In detail, basal cell carcinoma (BCC) is the most frequent malignancy in the fair-skinned population. The incidence of BCC remains difficult to assess due to the poor registration practice; however, it has been increasing in the last few years. Approximately, 85% of sporadic BCCs carry mutations in Hedgehog pathway genes, especially in PTCH, SUFU and SMO genes, which lead to the aberrant activation of GLI transcriptional factors, typically silent in cells of adult individuals. The management of advanced BCC (aBCC), both metastatic (mBCC) and locally advanced BCC (laBCC), not candidates for surgical excision or radiotherapy, remains challenging. The discovery of mutations in the Hh signaling pathway has paved the way for the development of Hh pathway inhibiting agents, such as vismodegib and sonidegib, which have represented a breakthrough in the aBCC management. However, the use of these agents is limited by the frequent occurrence of adverse events or the development of drug resistance. In this review, we thoroughly describe the current knowledge regarding the available options for the pharmacological management of aBCCs and provide a forward-looking update on novel therapeutic strategies that could enrich the therapeutic armamentarium of BCC in the near future.

The role of a cosmetologist in the area of health promotion and health education: A systematic review

Background: Contemporary cosmetology, apart from beautifying and caring for the human body, deals also with prevention aimed at maintaining health and physical fitness as long as possible. The profession of a cosmetologist so understood is closely related to the modern concept of health promotion, the part of which is health education. The objective of this review was to evaluate whether a cosmetologist may be a health promoter, and whether a beauty salon mayserve as a place for conducting educational programs.

Methods: A systematic review was done using several electronic databases such as PubMed(including MEDLINE), Web of Science Core Collection, Scopus, Embase, and Academic Search Ultimate (EBSCO) and related keywords. The studies published in English between 2008 and 2018 which had specifically mentioned the role of a cosmetologist in the area of health promotion and health education were included.

Results: In total, 7 articles met the study criteria. It was found that cosmetologists have the potential to promote pro-health activities. The results of this review also suggest that beauty salons are suitable places for increasing pro-health awareness and can be successfully used to conduct educational programs about healthy lifestyle, as well as skin, breast and cervical cancer prevention.

Conclusion: A well-educated and aware of health risks cosmetologist seems to be the right person to transmit and spread knowledge about the proper lifestyle in her workplace and the local environment. A beauty salon, as a place of social interaction, may constitute an area of implementation of pro-health educational programs.

Indoor tanning and skin cancer in Canada: A meta-analysis and attributable burden estimation

BACKGROUND

Consistent epidemiologic and experimental studies have demonstrated that UV-emitting tanning devices cause melanoma and non-melanoma skin cancer. The purpose of this study was to estimate the relative risk of skin cancer associated with the use of indoor tanning devices relevant to Canada, to estimate the proportion and number of skin cancers in Canada in 2015 that were attributable to indoor tanning, and to explore differences by age and sex.

METHODS

Skin cancer cases attributable to the use of an indoor tanning devices were estimated using Levin's population attributable risk (PAR) formula. Relative risks for skin cancer subtypes that were relevant to Canada were estimated through meta-analyses and prevalence of indoor tanning was estimated from the 2006 National Sun Survey. Age- and sex-specific melanoma data for 2015 were obtained from the Canadian Cancer Registry, while estimated NMSC incidence data were obtained from the 2015 Canadian Cancer Statistics report.

RESULTS

Ever use of indoor tanning devices was associated with relative risks of 1.38 (95% CI 1.22-1.58) for melanoma, 1.39 (1.10-1.76) for basal cell carcinoma (BCC), and 1.49 (1.23-1.80) for squamous cell carcinoma (SCC). Overall, 7.0% of melanomas, 5.2% of BCCs, and 7.5% of SCCs in 2015 were attributable to ever of indoor tanning devices. PARs were higher for women and decreased with age.

CONCLUSION

Indoor tanning contributes to a considerable burden of skin cancer in Canada. Strategies aimed at reducing use should be increased and a total ban or restrictions on use and UV-intensity should be considered by health regulators.

Mechanisms and prevention of UV-induced melanoma

Melanoma is the deadliest form of skin cancer and its incidence is rising, creating a costly and significant clinical problem. Exposure to ultraviolet (UV) radiation, namely UVA (315-400 nm) and UVB (280-315 nm), is a major risk factor for melanoma development. Cumulative UV radiation exposure from sunlight or tanning beds contributes to UV-induced DNA damage, oxidative stress, and inflammation in the skin. A number of factors, including hair color, skin type, genetic background, location, and history of tanning, determine the skin's response to UV radiation. In melanocytes, dysregulation of this UV radiation response can lead to melanoma. Given the complex origins of melanoma, it is difficult to develop curative therapies and universally effective preventative strategies. Here, we describe and discuss the mechanisms of UV-induced skin damage responsible for inducing melanomagenesis, and explore options for therapeutic and preventative interventions.

Skin Cancer Risk and Other Health Risk Behaviors: A Scoping Review

Purpose. To present results of a scoping review focused on skin cancer risk behaviors and other related health risk behaviors. Skin cancer is highly preventable, yet it is the most common form of cancer in the United States with melanoma rates increasing. Limited research has been conducted examining the relationship between skin cancer prevention behaviors and other health risks, yet multiple behavioral health risk interventions have shown great promise for health promotion and reduced health care costs. Methods. Online databases were searched for research articles on skin cancer risk behaviors and related health risk behaviors. Results. Thirty-seven articles met inclusion criteria examining skin cancer behaviors including risk, sun protection behaviors, sunburn, and indoor tanning. The majority of existing studies focused on the relationship between skin cancer prevention behaviors and physical activity, body mass index, smoking, and alcohol abuse. Adults were the primary population of interest with some studies of adolescents. Conclusions. Poor skin cancer prevention behaviors were associated with alcohol use, marijuana use, and smoking among adolescents and adults. Studies on body mass index and physical activity had mixed relationships with skin cancer prevention behaviors and warrant further investigation. Indoor tanning was associated with other risky behaviors but other skin cancer prevention behaviors were not studied.

Tanning bed use and melanoma: Establishing risk and improving prevention interventions

PURPOSE

Exposure to ultraviolet radiation (UVR) from indoor tanning devices is thought to cause melanoma and other negative health consequences. Despite these findings, the practice of indoor tanning in the United States remains prevalent. In this paper we aim to present a clear discussion of the relationship between indoor tanning and melanoma risk, and to identify potential strategies for effective melanoma prevention by addressing indoor tanning device use.

BASIC PROCEDURES

We reviewed relevant literature on the risks of indoor tanning, current indoor tanning legislation, and trends in indoor tanning and melanoma incidence. Study was conducted at the University of Southern California, Los Angeles, CA between the years of 2014 and 2015.

MAIN FINDINGS

Our findings reaffirm the relationship between indoor tanning and melanoma risk, and suggest a widespread public misunderstanding of the negative effects of indoor tanning.

PRINCIPAL CONCLUSIONS

This review argues for an aggressive initiative to reduce indoor tanning in the United States, to design prevention efforts tailored towards specific high risk groups, and the need to better inform the public of the risks of indoor tanning.

Ultra-violet indoor tanning addiction: a reinforcer pathology interpretation

Ultra-violet indoor tanning (UVIT) is a pervasive issue that is increasing at record rates, despite obvious and well-publicized links to skin cancer. Recent studies on UVIT have found that frequent users face difficulty quitting and report symptomatology similar to substance-related disorders, causing the medical field to begin classifying excessive UVIT use as an addicting behavior. Despite calls for research, relatively little behavioral research has been aimed at determining the psychology of UVIT. This mini-review reinterprets the existing dermatology literature in light of the reinforcer pathology model of addiction. The relevancy of this model, in conjunction with the similarities between UVIT addiction and other substance-related addiction, suggests that behavioral economic research on UVIT is overdue. This mini-review concludes with directions for future research in this area.

Photobiological implications of melanin photoprotection after UVB-induced tanning of human skin but not UVA-induced tanning

Repetitive suberythemal UVA and/or UVB exposures were used to generate comparable UV-induced tans in human skin over the course of 2 weeks. To evaluate the potential photoprotective values of those UVA- and/or UVB- induced tans and to avoid the confounding issue of residual UV-induced DNA damage, we waited 1 week before challenging those areas with a 1.5 MED of UVA+UVB after which we measure DNA damage. The results show that the type of UV used to induce skin pigmentation affects the redistribution of melanin in the skin and/or de novo melanin synthesis. The UVA-induced tans failed to even provide a minimal SPF of 1.5, which suggests that producing a tan with UVA-rich sunlamps prior to a holiday or vacation is completely counterproductive.

Mechanisms and treatments of photoaging

Photoaging is frequently encountered in a dermatologic practice. This systematic literature review aims to explore the etiology of photoaging and address the evidence behind its current management. A comprehensive search of MEDLINE, EMBASE, UpToDate, and the Cochrane Library was conducted. Articles were limited to those relating to photoaging. There are two major approaches in the current management of photoaging. This includes strategies to prevent against ultraviolet damage (e.g. sunscreen) and medications that attempt to reverse existing skin damage (topical retinoids and 5-fluorouracil). There has been a large growth in the variety of treatment options in recent years. While it is important for such growth to continue, prevention via sensible photoprotection methods still remains the best current management option.

Tanning accelerators: prevalence, predictors of use, and adverse effects

BACKGROUND

Tanning accelerators are topical products used by indoor tanners to augment and hasten the tanning process. These products contain tyrosine, psoralens, and/or other chemicals.

OBJECTIVE

We sought to better define the population using accelerators, identify predictors of their use, and describe any related adverse effects.

METHODS

This cross-sectional study surveyed 200 indoor tanners about their tanning practices and accelerator use. Primary analysis compared accelerator users with nonusers with respect to questionnaire variables. Descriptive statistics and χ(2) contingency tables were applied to identify statistically significant variables.

RESULTS

Of respondents, 53% used accelerators; 97% were female and 3% were male with a median age of 22 years (range: 19-67). Users were more likely to spray tan, tan frequently, and be addicted to tanning. Acne and rashes were more common in accelerator users. Adverse reactions to accelerators prevented their further use 31% of the time.

LIMITATIONS

A limited adult population was evaluated; exact accelerator ingredients were not examined.

CONCLUSIONS

Tanning accelerator users are high-risk indoor tanners who tan more frequently and who are more likely addicted to tanning. Acne and rashes are more common with these products and act as only mild deterrents to continued use. Additional research should investigate accelerators' longer-term health effects.

Early-onset basal cell carcinoma and indoor tanning: a population-based study

OBJECTIVE

Indoor tanning with UV radiation-emitting lamps is common among adolescents and young adults. Rising incidence rates of basal cell carcinoma (BCC) have been reported for the United States and elsewhere, particularly among those diagnosed at younger ages. Recent epidemiologic studies have raised concerns that indoor tanning may be contributing to early occurrence of BCC, and younger people may be especially vulnerable to cancer risk associated with this exposure. Therefore, we sought to address these issues in a population-based case-control study from New Hampshire.

METHODS

Data on indoor tanning were obtained on 657 cases of BCC and 452 controls ≤50 years of age.

RESULTS

Early-onset BCC was related to indoor tanning, with an adjusted odds ratio (OR) of 1.6 (95% confidence interval, 1.3-2.1). The strongest association was observed for first exposure as an adolescent or young adult, with a 10% increase in the OR with each age younger at first exposure (OR per year of age ≤23 = 1.1; 95% confidence interval, 1.0-1.2). Associations were present for each type of device examined (ie, sunlamps, tanning beds, and tanning booths).

CONCLUSIONS

Our findings suggest early exposure to indoor tanning increases the risk of early development of BCC. They also underscore the importance of counseling adolescents and young adults about the risks of indoor tanning and for discouraging parents from consenting minors to this practice.

Skin cancer: role of ultraviolet radiation in carcinogenesis

UV radiation is a carcinogen known to play a role in the development of non-melanoma and melanoma skin cancers. Acute and chronic exposure to UV radiation causes clinical and biological effects that promote the unregulated proliferation of skin cells. In recent decades, changes in climate and increased air pollution have led to environmental changes that increase UV light transmission. In this chapter, we discuss sources of UV radiation that are relevant to human health, as well as the acute and chronic effects that result from UV radiation exposure.

The role of optical radiations in skin cancer

Purpose. Electromagnetic radiation with wavelength in the range 100 nm to 1 mm is known as optical radiation and includes ultraviolet radiation, the visible spectrum, and infrared radiation. The deleterious short- and long-term biological effects of ultraviolet radiation, including melanoma and other skin cancers, are well recognized. Infrared radiation may also have damaging biological effects. Methods. The objective of this review was to assess the literature over the last 15 years and to summarize correlations between exposure to optical radiation and the risk of melanoma and other cancers. Results. There is a clear correlation between exposure to UV radiation and the development of skin cancer. Most importantly, a strong association between artificial UV radiation exposure, for example, tanning devices, and the risk of melanoma and squamous cell carcinoma has been clearly demonstrated. There is no clear evidence that exposure to IR and laser radiation may increase the risk of skin cancer, although negative health effects have been observed. Conclusions. Preventative strategies that involve provision of public information highlighting the risks associated with exposure to sunlight remain important. In addition, precautionary measures that discourage exposure to tanning appliances are required, as is legislation to prevent their use during childhood.

Adverse effects of ultraviolet radiation from the use of indoor tanning equipment: time to ban the tan

The incidence of melanoma skin cancer is increasing rapidly, particularly among young women in the United States. Numerous studies have documented an association between the use of indoor tanning devices and an increased risk of skin cancer, especially in young women. Studies have shown that ultraviolet exposure, even in the absence of erythema or burn, results in DNA damage. Countries and regulatory bodies worldwide have recognized the health risks associated with indoor tanning. In the United States, 32 states have passed legislation to regulate the indoor tanning industry, but there is an urgent need to restrict the use of indoor tanning devices at the federal level. The Food and Drug Administration is currently reviewing the classification of these devices. For all of these reasons, the Food and Drug Administration should prohibit the use of tanning devices by minors and reclassify tanning devices to at least class II to protect the public from the preventable cancers and other adverse effects caused by ultraviolet radiation from indoor tanning.

Comparison of advertising strategies between the indoor tanning and tobacco industries

The indoor tanning industry is large and continues to grow, with 2007 domestic sales in excess of $5 billion. Advertising is central to shaping the consumer's perception of indoor tanning as well as driving industry demand. This article aims to identify key drivers of consumer appeal by comparing tanning advertising strategies to those used by tobacco marketers. Tobacco advertising was selected as a reference framework because it is both well documented and designed to promote a product with known health hazards. Two thousand advertisements from 4 large tobacco advertisement databases were analyzed for type of advertisement strategy used, and 4 advertising method categories were devised to incorporate the maximum number of advertisements reviewed. Subsequently, contemporary tanning advertisements were collected from industry magazines and salon websites and evaluated relative to the identified strategy profiles. Both industries have relied on similar advertising strategies, including mitigating health concerns, appealing to a sense of social acceptance, emphasizing psychotropic effects, and targeting specific population segments. This examination is a small observational study, which was conducted without rigorous statistical analysis, and which is limited both by the number of advertisements and by advertising strategies examined. Given the strong parallels between tobacco and tanning advertising methodologies, further consumer education and investigation into the public health risks of indoor tanning is needed.

Tanning, skin cancer risk, and prevention: a content analysis of eight popular magazines that target female readers, 1997-2006

The majority of tanning bed users in the U.S. are women. Previous health communication research frequently focused on the risk of skin cancer, but few studies assessed the mediated communication environment that may surround women's beliefs and behaviors relevant to tanning. A content analysis of articles in eight magazines targeting girls, young women, older women, and women who are interested in fitness during the ten-year period of 1997-2006 was conducted. The amount of coverage of tanning bed use consequences was less than 50% of the coverage of tanning benefits. About 40% of the tanning benefits coverage touted looking healthy. The coverage of prevention methods focused on sunscreen use (55%), while the more important methods (e.g., protective clothing use) were rarely featured. Longitudinally, the coverage of the risk and prevention relevant issues increased between 1997 and 2006. The data indicate that the coverage of tanning benefits also increased during the same period.

Sun exposure and vitamin D sufficiency

Ultraviolet radiation is a carcinogen that also compromises skin appearance and function. Because the ultraviolet action spectra for DNA damage, skin cancer, and vitamin D(3) photosynthesis are identical and vitamin D is readily available from oral supplements, why has sun protection become controversial? First, the media and, apparently, some researchers are hungry for a new message. Second, the controversy is fueled by a powerful special interest group: the tanning industry. This industry does not target the frail elderly or inner-city ethnic minorities, groups for whom evidence of vitamin D(3) insufficiency is strongest, but rather fair-skinned teenagers and young adults, who are at highest risk of ultraviolet photodamage. Third, evolution does not keep pace with civilization. When nature gave humans the appealing capacity for cutaneous vitamin D(3) photosynthesis, life expectancy was <40 y; long-term photodamage was not a concern; and vitamin D(3) deficiency, with its resulting skeletal abnormalities (rickets), was likely to be fatal in early life. In the 21st century, life expectancy approaches 80 y in developed countries, vitamin D(3) is available at the corner store, and the lifetime risk of skin cancer is 1 in 3 among white Americans. Medical and regulatory groups should avoid poorly reasoned, sensationalistic recommendations regarding unprotected ultraviolet exposure. Instead, they should rigorously explore possible cause-and-effect relations between vitamin D(3) status and specific diseases while advocating the safest possible means of ensuring vitamin D(3) sufficiency.

Tanning and cutaneous malignancy

BACKGROUND

Exposure to ultraviolet radiation (UVR) results in a darkening of the skin known as tanning. Recently, it has been shown that tanning is a response to UVR-induced DNA damage and represents the skin's efforts to protect itself against further injury. Despite the link between UVR and cutaneous malignancy, people continue to pursue tanning from natural and artificial sources. This trend is reflected in the exponential rise in skin cancer incidence.

OBJECTIVE

The objective of this study was to review our current understanding of the factors controlling the tanning response and the relationship to cutaneous carcinogenesis, as well as the impact that the multibillion dollar tanning industry has had on the practice of dermatology.

MATERIALS AND METHODS

Extensive literature review was conducted in subjects related to tanning and the relationship to cutaneous malignancy.

RESULTS

Our knowledge of tanning and its effects on the skin has increased tremendously. It is clear that tanning contributes to the development of skin cancer. Despite this information, the incidence of skin cancer continues to increase exponentially.

CONCLUSIONS

Skin cancer poses a major public health concern and tanning remains the most modifiable risk factor in its etiology. Social, economic, and legislative issues have become tightly intertwined with the complex nature of human behavior in the continued pursuit of an activity that clearly has detrimental effects on one's health.

Regulation of human skin pigmentation and responses to ultraviolet radiation

Pigmentation of human skin is closely involved in protection against environmental stresses, in particular exposure to ultraviolet (UV) radiation. It is well known that darker skin is significantly more resistant to the damaging effects of UV, such as photocarcinogenesis and photoaging, than is lighter skin. Constitutive skin pigmentation depends on the amount of melanin and its distribution in that tissue. Melanin is significantly photoprotective and epidermal cells in darker skin incur less DNA damage than do those in lighter skin. This review summarizes current understanding of the regulation of constitutive human skin pigmentation and responses to UV radiation, with emphasis on physiological factors that influence those processes. Further research is needed to characterize the role of skin pigmentation to reduce photocarcinogenesis and to develop effective strategies to minimize such risks.

The association of use of sunbeds with cutaneous malignant melanoma and other skin cancers: A systematic review

Exposure to solar ultraviolet (UV) radiation is a known cause of skin cancer. Sunbed use represents an increasingly frequent source of artificial UV exposure in light-skinned populations. To assess the available evidence of the association between sunbed use and cutaneous malignant melanoma (melanoma) and other skin cancers, a systematic review of the literature till March 2006 on epidemiological and biological studies on sunbed use was performed in Pubmed, ISI Web of Science, Embase, Pascal, Cochrane library, Lilacs and Medcarib. Search for keywords in the title and in the abstract was done systematically and supplemented by manual searches. Only case-control, cohort or cross-sectional studies were selected. Data were abstracted by means of a standardized data-collection protocol. Based on 19 informative studies, ever-use of sunbeds was positively associated with melanoma (summary relative risk, 1.15; 95% CI, 1.00-1.31), although there was no consistent evidence of a dose-response relationship. First exposure to sunbeds before 35 years of age significantly increased the risk of melanoma, based on 7 informative studies (summary relative risk, 1.75; 95% CI, 1.35-2.26). The summary relative risk of 3 studies of squamous cell carcinoma showed an increased risk. For basal cell carcinoma, the studies did not support an association. The evidence does not support a protective effect of the use of sunbeds against damage to the skin from subsequent sun exposure. Young adults should be discouraged from using indoor tanning equipment and restricted access to sunbeds by minors should be strongly considered.

Sun protection and Vitamin D: three dimensions of obfuscation

Ultraviolet (UV) radiation is a proven carcinogen, responsible for more than half of all human malignancies. It also compromises skin appearance and function. Since the UV action spectra for DNA damage, skin cancer and Vitamin D(3) (vit D) photosynthesis are identical and vit D is readily available from oral supplements, why has sun protection become controversial, now that some data suggest conventionally "sufficient" levels of vit D may be less than optimal for at least some population groups? First, the media and apparently some researchers are hungry for a new message. Nevertheless, after 50 years, UV exposure is still a major avoidable health hazard. Second, the controversy is fueled by a powerful special interest group: the indoor tanning industry. They target not the frail elderly or inner-city ethnic minorities, groups for whom evidence of vit D insufficiency is strongest, but rather fair-skinned teenagers and young adults, those at highest risk of UV photodamage. Third, evolution does not keep pace with civilization. When nature gave man the appealing capacity for vit D photosynthesis, the expected lifespan was far less than 40 years. Long-term photodamage was not a concern, and vit D was not available at the corner store. The medical community should avoid sensationalism and instead rigorously explore possible cause-and-effect relationships between vit D status and specific diseases while advocating the safest possible means of assuring vit D sufficiency.

Measuring the stringency of states' indoor tanning regulations: instrument development and outcomes

OBJECTIVES

We sought to describe the development of an instrument to quantify the stringency of state indoor tanning legislation in the United States, and the instrument's psychometric properties. The instrument was then used to rate the stringency of state laws.

METHODS

A 35-item instrument was developed. An overall stringency measure and 9 stringency subscales were developed, including one measuring minors' access to indoor tanning. Stringency measures showed good internal consistency and interrater reliability.

RESULTS

In all, 55% of the 50 states and the District of Columbia had any indoor tanning law, and 41% had any law addressing minors' access. Oregon, Illinois, South Carolina, Florida, Indiana, Iowa, and Rhode Island had high overall stringency scores, and Texas and New Hampshire were the most restrictive with regard to minors' access.

LIMITATIONS

Measurement of actual enforcement of the laws was not included in this study.

CONCLUSIONS

The instrument appears to be an easy-to-use, reliable, and valid methodology. Application of the instrument to actual laws showed that, in general, state laws are relatively weak, although there was considerable variability by state.

Effect of light irradiation and sex hormones on jurkat T cells: 17beta-estradiol but not testosterone enhances UVA-induced cytotoxicity in Jurkat lymphocytes

In Eastern cultures, such as India, it is traditionally recommended that women but not men cover their heads while working in the scorching sun. The purpose of this pilot study was to determine whether there was any scientific basis for this cultural tradition. We examined the differential cytotoxic effects of ultraviolet A light (UVA) on an established T cell line treated with female and male sex hormones. CD4⁺ Jurkat T cells were plated in 96 well plates at 2 × 10⁶ cells/ml and treated with 17β-estradiol (EST) or testosterone (TE). These cells were irradiated by UVA light with an irradiance of 170 J/cm² for 15min at a distance of 6 cm from the surface of the 96-well plate. Controls included cells not treated with hormones or UVA. The effects of EST and TE were investigated between 1 and 20 ng/mL. Cytotoxicity by fluorescein-diacetate staining and COMET assay generating single strand DNA cleavage, tail length and tail moment measurements were examined. The effect of estrogen (5ng/mL) on apoptosis and its mediators was further studied using DNA laddering and western blotting for bcl-2 and p53. We found that EST alone, without UVA, enhanced Jurkat T cell survival. However, EST exhibited a dose-related cytotoxicity in the presence of UVA; up to 28% at 20 ng/ml. TE did not alter UVA-induced cytotoxicity. Since TE did not alter cell viability in the presence of UVA further damaging studies were not performed. COMET assay demonstrated the harmful effects of EST in the presence of UVA while EST without UVA had no significant effect on the nuclear damage. Apoptosis was not present as indicated by the absence of DNA laddering on agarose gel electrophoresis at 5ng/ml EST or TE ± UVA. Western blot showed that estrogen down regulated bcl-2 independently of UVA radiation while p53 was down regulated in the presence of UVA treatment. EST and TE have differential effects on UVA-induced cytotoxicity in Jurkat T-lymphocyte which suggested that women may be more susceptible to the harmful effects of solar irradiation than men.

Do adolescent indoor tanners exhibit dependency?

BACKGROUND

Indoor tanning is a common adolescent risk behavior that has been hypothesized to be motivated and maintained by the mood-altering effects of ultraviolet light.

OBJECTIVE

Our purpose was to explore heretofore anecdotal reports that indoor tanning leads to dependency.

METHODS

A telephone interview was conducted among 1275 adolescents, ages 14 to 17 years. Self-reported difficulty in quitting indoor tanning was assessed among 267 adolescents (20.9% of total) who tanned indoors more than once in the previous year in relation to age of initiation, frequency of use, and positive or negative consequences of the practice.

RESULTS

Difficulty in quitting was more likely with younger age at initiation (age 13 years or younger vs ages 16 to 17; odds ratio = 4.3, 95% confidence interval 1.3-14.7) and higher frequency of use (P = .009), even after accounting for positive or negative consequences of indoor tanning and other demographic characteristics.

LIMITATIONS

This was a cross-sectional study design with a limited outcome measure.

CONCLUSION

Although preliminary, our findings for age at initiation and frequency of use in relation to difficulty in quitting indoor tanning are consistent with other potentially addictive behaviors taken up during adolescence.

Cutaneous malignant melanoma: facts about sunbeds and sunscreen

The incidence of cutaneous malignant melanoma is still increasing in most light-skinned populations. Sunscreen use has been proposed for the primary prevention of melanoma. However, sunscreen use may increase time spent in the sun when users are willing to acquire a tan or to stay in the sun for a long time, which may increase melanoma risk. When sun exposure is not associated with the desire to acquire a tan or stay in the sun for a long time, sunscreen use may prevent squamous cell skin carcinoma. Sun protection should give priority to clothing and sun exposure reduction. Over the last 20 years, tan acquisition through exposure to artificial sources of ultraviolet radiation has become frequent among fair-skinned adolescents and young adults. There is accumulating evidence that sunbed use is associated with melanoma when started before approximately 30 years of age.

Seasonal variations of DNA damage in human lymphocytes: correlation with different environmental variables

Several types of DNA damage, including DNA breaks and DNA base oxidation, display a seasonal trend. In the present work, a sample of 79 healthy subjects living in the city of Florence, Italy, was used to analyse this effect. Three possible causative agents were taken into consideration: solar radiation, air temperature and air ozone level. DNA damage was measured in isolated human lymphocytes at different times during the year and the observed damage was correlated with the levels of these three agents in the days preceding blood sampling. Three time windows were chosen: 3, 7 and 30 days before blood sampling. DNA strand breaks and the oxidized purinic bases cleaved by the formamidopyrimidine glycosylase (FPG sites) were measured by means of the comet assay. The results of multivariate regression analysis showed a positive correlation between lymphocyte DNA damage and air temperature, and a less strong correlation with global solar radiation and air ozone levels.

The indoor UV tanning industry: A review of skin cancer risk, health benefit claims, and regulation

BACKGROUND

Nearly 30 million people tan indoors in the United States annually, including 2.3 million adolescents. Despite increased evidence on the dangers of artificial UV radiation, the popularity of indoor tanning is growing.

OBJECTIVES

We aim to assess the following 3 entities: (1) the association of indoor tanning with skin cancer; (2) statements regarding the health benefits of indoor tanning, especially regarding the production of vitamin D; and (3) current regulation of the tanning industry in the United States.

METHODS

We conducted a narrative review of the literature.

RESULTS

Indoor tanning poses great risks. Studies support the role of artificial UV radiation in cutaneous carcinogenesis. Despite claims by the tanning industry, artificial tanning is not a safe or necessary way to increase systemic vitamin D levels. The National Institutes of Health and the World Health Organization have acknowledged the risks of indoor tanning. Nonetheless, regulations limiting tanning in the United States are surprisingly sparse.

LIMITATIONS

Systematic review of the literature was not performed.

CONCLUSIONS

Health care providers must increase efforts to warn and educate the public and government about the dangers of UV radiation.

Tanning and skin cancer

Skin cancer is a large and growing problem in the United States. Sun and other ultraviolet (UV) light exposures play a key role in the development of skin cancer. Pediatricians can play an important role in counseling patients and are in a position to help educate children and their families about skin cancer. The purpose of this review is to familiarize pediatricians with the magnitude of the skin cancer problem and the evidence that ultraviolet light exposure, particularly indoor tanning, contributes to this problem. We reviewed the literature on ultraviolet light and skin cancer (based on a MEDLINE search of articles using the headings "ultraviolet light" and "skin cancer") and found that skin cancer is the most rapidly growing cause of cancer deaths in the United State. There is strong epidemiologic evidence for the relationship between UV exposure and nonmelanoma skin cancer and growing evidence for the relationship between indoor tanning and melanoma. We recommend that pediatricians counsel children and their parents about UV protection. Measures such as use of sunscreen and hats for outdoor play, both at home and in school, should be encouraged.

Ultraviolet exposure is a reinforcing stimulus in frequent indoor tanners

BACKGROUND

Investigations into tanners' reasons for tanning have focused primarily on the perception of improved appearance. Reported relaxing effects of tanning suggest the possibility of a physiologic effect of UV that drives tanning behavior.

OBJECTIVE

We sought to determine if there is a physiologic reinforcing effect of UV exposure, separate from appearance motivation, that may contribute to tanning behavior.

METHODS

We determined the reinforcing effect of UV light in a series of controlled, blinded, repeated-choice trials of UV carefully designed to separate as cleanly as possible reinforcing effects of UV exposure from other factors including perceived benefits of having a tan. A total of 14 young adults who used tanning beds regularly were exposed to otherwise identical UV and non-UV tanning bed stimuli on Mondays and Wednesdays for 6 weeks. On Fridays, participants had concurrent access to the two beds. The primary dependent variable was the percentage of choice sessions during which more UV than non-UV tanning was chosen.

RESULTS

In all, 12 participants chose additional tanning exposure on Fridays and, of these, 11 consistently used the UV bed for that exposure. Of the total 41 occasions when participants chose to tan on Friday, 39 sessions (95%) were for the UV bed and only two for the non-UV bed. A more relaxed and less tense mood was reported after UV exposure compared with after non-UV exposure (P=.008 and P=.002, respectively).

DISCUSSION

When exposed to UV and non-UV under blinded conditions, frequent tanners can distinguish the two conditions and undertake further UV exposure, indicating that UV is a reinforcing stimulus. The relaxing and reinforcing effects of UV exposure contribute to tanning behavior in frequent tanners and should be explored in greater detail.

Environmental risk factors predisposing to the development of basal cell carcinoma

BACKGROUND

Basal cell carcinomas (BCCs) are the most common malignancies in white people. The incidence varies depending on the region of the world, with the highest rate of 1% to 2% per year noted in Australia. It is estimated that BCC incidence increases by 5% annually. An increasing incidence of BCC is in line with the changes in the living style and exposure to various environmental factors.

OBJECTIVE

To present the environmental factors that may influence the development of BCCs. The influence of ultraviolet radiation exposure alone and in connection with immunosuppression, smoking, occupational factors, as well as arsenic and ionizing radiation exposure, was described.

CONCLUSION

BCC is a very complex disease, with many factors influencing its development. Environmental factors are very important for the prevalence of BCC, and most of them can be avoided. The exposure to ultraviolet radiation is undoubtedly of great risk; therefore, the national campaigns against aggressive, seasonal sun exposure, especially in children and adolescents, as well as using sunscreens, are of great value in the fight against BCC development.

Tanning Devices - Fast Track to Skin Cancer?

The use of UVB and/or UVA emitting devices for cosmetic tanning is widespread in Western populations including young people and is especially prevalent in females. Several epidemiological studies, although not all, have shown a significant relationship between the use of tanning devices and malignant melanoma after, in some cases, adjustment for confounding factors such as solar ultraviolet radiation (UVR) exposure. A relationship between solar exposure, especially intermittent exposure, and malignant melanoma is well established so it is not surprising that a similar connection has been reported for the use of tanning devices. Several epidemiological studies show that childhood exposure to sunlight is a risk factor for malignant melanoma and this may also be the case for the use of tanning devices, especially if sunburns are obtained. Some studies have evaluated the relationship between the use of tanning devices and non-melanoma skin cancer and at least one has suggested an association. The use of tanning devices by a substantial minority of young people is a worrying trend in terms of a likely increased incidence of malignant melanoma, and possibly non-melanoma cancers in the future. Although two recent reviews by epidemiologists conclude that a clear link between tanning devices and malignant melanoma is yet to be proven, there is a strong case for effective legislation to prohibit the use of tanning devices by people under 18 yr of age.

The evolution of current medical and popular attitudes toward ultraviolet light exposure: part 3

In the 1930s, attitudes toward ultraviolet (UV) light exposure began to change significantly within the medical profession. UV radiation had been promoted as healthful since the century's start, and particularly after the discovery of its role in vitamin-D metabolism. Increasingly, however, attention would focus on the risks of UV light exposure from sunlamps and sunbathing. During this time, the American Medical Association established guidelines for the approval of UV lamps and the appropriate therapeutic uses of phototherapy. The landmark experiments of Findlay and other researchers, in which malignant skin tumors were induced in rodents after exposure to UV lamps or sunlight, would lead to widespread recognition of the carcinogenicity of UV radiation. The role of sunlight in the etiology of skin cancer was increasingly mentioned in articles in popular magazines in the 1940s and 1950s. There was rapid growth of the sunscreen industry as well, although product efficacy remained highly variable. In the 1950s, interest developed in the use of 8-methoxypsoralen ("the suntan pill") and dihyroxyacetone ("suntan in a bottle"). In spite of the known risks of UV exposure and attempts by physicians and other health professionals to educate the public and modify behavior, suntanning has remained tenaciously popular. Today, excessive UV light exposure is recognized as the major cause of the approximately 1.3 million cases of skin cancer in the United States each year.

Tanning facility use: are we exceeding Food and Drug Administration limits?

BACKGROUND

The US Food and Drug Administration (FDA) recommends exposure limits for tanning bed use. Tanning patrons may not be following these recommendations and may be overexposed to damaging ultraviolet radiation (UV).

OBJECTIVE

This study was conducted to assess tanning patrons' adherence to FDA-recommended exposure limits and to measure the amount of UVA and UVB radiation emitted by tanning beds.

METHODS

A community-based survey was administered during routine state inspections of North Carolina tanning facilities (n = 50). At each facility, patron records were randomly selected (n = 483) for a survey of exposure records, and UVA and UVB outputs were measured for each tanning bed.

RESULTS

The recommended limits were exceeded by 95% of patrons, and 33% of patrons began tanning at the maximum doses recommended for maintenance tanning. Average tanning bed output was 192.1 W/m(2) UVA and 0.35 W/m(2) erythemally weighted UVB.

CONCLUSIONS

Interventions for tanning bed operators and patrons are needed to increase compliance with federally recommended exposure limits.

Double exposure: natural and artificial ultraviolet radiation exposure in beachgoers

BACKGROUND

Although the beach is a high-risk environment for ultraviolet light exposure and subsequent skin damage, little is known about beachgoer tanning habits outside the beach setting. Our purpose was to evaluate indoor tanning and additional, nonbeach sunlight exposure in a beachgoing population.

METHODS

We conducted an epidemiologic survey.

RESULTS

There was more use of indoor tanning salons among sunbathing beachgoers who applied little or no skin protection from the sun (50.8% [31 of 61 respondents]) compared with nonsunbathing beachgoers (22.7% [5 of 22 respondents]). In addition to increased use of tanning salons, we observed that poorly protected sunbathers tanned at locations other than the beach on a regular basis (50.8% [31 of 61 respondents]) more than nonsunbathers did (9.1% [2 of 22 respondents]).

CONCLUSION

Beachgoing sunbathers often used both natural sunlight and tanning beds, subjecting themselves to two forms of ultraviolet radiation exposure.

Risk assessment and early detection of skin cancers

OBJECTIVES

To describe a systematic method for skin cancer assessment, applying current standard practices for integration into nursing practice. To provide the fundamentals of performing a skin cancer assessment for the nonmelanoma skin cancers, basal cell carcinoma, and squamous cell carcinomas, and melanoma. Included in this discussion are risk profile calculations, mechanics of skin cancer assessment, descriptions of suspicious lesions, patient management, and follow-up.

DATA SOURCES

Textbooks, research, review of the literature, and clinical experience.

CONCLUSIONS

Skin cancer assessment is a skill that nurses can learn and implement into practice.

IMPLICATIONS FOR NURSING PRACTICE

Knowledge and practice of good skin cancer assessment skills enhances nursing competence and positively influences patient outcomes.

Use of indoor tanning sunlamps by US youth, ages 11-18 years, and by their parent or guardian caregivers: prevalence and correlates

BACKGROUND

Tanning parlors have become common in the United States. Artificial ultraviolet radiation exposure from this source may be harmful and may increase the risk of melanoma, particularly when done for recreational purposes during childhood and early adult years. Population-based data on the prevalence and correlates of this activity is important in the evaluation of potential public health interventions for skin cancer prevention.

STUDY DESIGN

In 1998, we conducted a population-based telephone survey of youth and their primary caregiver. The sample (N = 1192) was weighted to represent the population of US youth living in households with a primary caregiver. Interviewers used a standardized questionnaire to document the characteristics of the participant and their practices, attitudes, and experiences regarding ultraviolet exposures. METHOD OF ANALYSIS: Weighted prevalence and adjusted prevalence odds ratios (aPOR) and 95% confidence interval (95% CI) were estimated. Independent factors were evaluated with multivariate logistic regression.

RESULTS

Ten percent of youth and 8% of their primary caregivers used indoor tanning sunlamps in the previous year. Thirty percent of the youth whose caregivers used indoor tanning sunlamps did so themselves as well. Independent predictors associated with indoor tanning sunlamp use were as follows: age 17 to 18 years (aPOR = 11.1; 95% CI: 5.0, 25.0); female (aPOR = 8.3; 95% CI: 3.6, 19.2); having a parent who used indoor tanning sunlamps in the previous year (aPOR = 8.7; 95% CI: 4.0, 18.9); nonuser of Sun Protection Factor 15 sunscreen at the beach or pool (aPOR = 1.9; 95% CI: 1.0, 3.4); and low sun sensitivity (aPOR = 2.3; 95% CI: 1.0, 5.3).

CONCLUSION

A substantial minority of American youth engages in indoor tanning. However, it is particularly prevalent among older youth, girls, and youth whose parents themselves use indoor tanning sunlamps. The knowledge of these trends may help focus public health initiatives.