Kavita Mariwalla, MD
Dr. Mariwalla is the Director of Dermatologic Surgery, Continuum Cancer Centers of New York, New York.
Dr. Mariwalla reports no conflicts of interest in relation to this post.
BMJ recently published a meta-analysis (2012;345:e5909) correlating indoor tanning use with nonmelanoma skin cancer. Although dermatologists have long known of this link, this analysis is important because it gives us concrete numbers that we can provide to our patients. The authors looked at 12 studies including 9328 cases of nonmelanoma skin cancer. The relative risk for developing squamous cell carcinoma was 1.67 among people who reported ever using indoor tanning compared with those who never used indoor tanning. For basal cell carcinoma, it was 1.29. Although relative risk numbers may seem foreign to the general public, the authors also were able to calculate that in the United States approximately 170,000 cases of nonmelanoma skin cancer each year can be attributed to indoor tanning. And if tanning bed use occurred before the age of 25 years, the relative risk was higher (2.02 for squamous cell carcinoma and 1.40 for basal cell carcinoma). Of the 12 studies analyzed, 10 were for ever exposed to indoor tanning (meaning even once), while 2 examined regular use (more than 5 times per year).
What’s the issue?
These data indicate that all dermatologists should be screening for indoor tanning bed use during every total body skin examination. I routinely ask my patients if they have ever used a tanning bed. I consider it a risk factor for development of nonmelanoma skin cancer, similar to the way I would risk-stratify a person for the development of melanoma if he/she had a positive family history of the disease. In my Mohs micrographic surgery practice, I find that in patients younger than 50 years who present for nonmelanoma skin cancer removal on the face, a majority have used a tanning bed at some point. What do you do? Will these data change how you practice medicine?