Ban the Tan!

Yes, folks, I am, once again, revisiting the subject of indoor tanning; the dangers associated with tanning and the subsequent increase of melanoma skin cancer among women in their 20s and 30s. It is a subject I’m passionate about (and, besides, this is a Blog about skin cancer prevention).

I received an email from the Environmental Protection Agency (EPA) recently that included an article that headlined "Palm Beach Tan® In-Lobby Video, 'Life Needs Color', Wins Two Prestigious Telly Awards". My initial reaction was disbelief - We are applauding indoor tanning and encouraging its use? WHAT?! Granted, the awards were given likely based on advertising creativity and commercial broadcasting. Nevertheless, the fact we are promoting the use of tanning beds without taking into consideration the dangers associated with it is, to me, not only irresponsible but perhaps even morally questionable. Is it not unethical to perpetuate the illusion of a “safe tan” when, in fact, it is biologically impossible to achieve a “safe tan”? Regardless of whether or not a tan is considered ideal, it doesn’t mean that it is safe. Because, well, it’s not safe. In fact, it’s quite the opposite. A tan is your skin's way of saying "I have sustained damage"; therefore, tanning is dangerous.

I am suddenly reminded of a 15-year-old girl who, during a public meeting in Northern Utah last year (when discussing legislation to limit minors' use of indoor tanning beds) unabashedly exclaimed:

“It's my right be tan [...] At least I will die beautiful!"

(I could not help but think, “It’s your right to die young?”)

Truth be told, not everyone who has used a tanning bed will be diagnosed with melanoma skin cancer. Yet, it is a FACT that exposure to ultraviolet radiation, over time, has cumulative effects including weakening of the elasticity in your skin, expedited aging and wrinkling and freckling, weakening of the immune system and MELANOMA. In fact, ultraviolet radiation has been identified as a known carcinogen, meaning that it’s cancer-causing. UV rays have cumulative effects on a variety of biological systems one of which is a heightened propensity toward developing melanoma – the deadliest form of skin cancer.

After working with the skin cancer community over the past several years, and teaching thousands of high school and college students, it never ceases to frighten me when I hear statements such as the one above; to learn that many young adults really don't think that skin cancer is a serious health concern not to mention that it can actually kill.

I am reminded of Charlie Guild. Charlie was 24 and preparing to go to medical school when she succumbed to malignant melanoma. Her mother, Valerie, with whom I worked on getting legislation regulating minors' use of tanning beds passed here in Utah (Valerie really championed this bill, which passed earlier this year), once told me: "I can still remember hearing Charlie tell her friends 'it's just skin cancer [...] no one really dies from skin cancer'." Well, Charlie had been diagnosed with the deadliest form of skin cancer -- melanoma, which is known as one of the most aggressive forms of cancer.

Often, when I'm giving a skin cancer presentation or hosting a training seminar, I mention melanoma warriors such as Charlie, Colette, and Scarlet -- bright and beautiful young women who, like me, were in their 20s but melanoma came and them of their future. I also share the stories of melanoma survivors such as 24-year-old MaryAnn Gerber and Brittany Leitz, the former Miss Maryland, and former professional body-building-turned-five-time-melanoma-champion Robin Lawrence. Robin, who lives in fear she won't see her daughter graduate high school, has spoken candidly about her quasi love affair with tanning beds while in her 20s, and how that cumulative exposure to ultraviolet radiation has contributed to hundreds (and counting) of biopsies.

“The question I kept asking myself was 'Why me?’” Lawrence says. "After looking back on my life, I realized I had only myself to blame. But I can honestly say that when I was growing up, I knew very little about the dangers of tanning or the threat of skin cancer. It's so ironic that my pursuit of a healthy, active lifestyle was what would eventually come back years later to threaten my life." (Learn more about Robin in ONLY SKIN DEEP? An Essential Guide to Effective Skin Cancer Programs and Resources.)

I think about these young women, who thought tanning was safe, and have since had a brush with an aggressive and lethal (but preventable) cancer. I share their stories with other young adults while giving a seminar on skin cancer prevention, sun safety, and skin care. Yet, I wonder how much of this information actually sticks; how much of it stays with my students? I can see their shock and sorrow when they see pictures of these melanoma warriors (such as Joanne pictured above) and even cry when they hear about the struggle and tragedy these melanoma warriors faced. Yet, I wonder how long those feelings last. They are reconsidering using a tanning bed now, because the image of this woman who has battled melanoma and the story of a 28-year-old mother of brand-new baby have touched their hearts and opened their eyes, but will they remember? Will it be enough to change their behavior?

I wonder –

What’s it going to take to convince people? I realize that people have a choice, but if I could effectively emphasis the seriousness of this disease; that it is preventable, but we must take proactive steps to try and protect ourselves from it and, if we don’t, we pay the ultimate price – an untimely death. If only I could bridge the gap between awareness and action; how do I make young people realize that tanning isn’t worth the risk?

These are a few (of the many) questions I wrestle with each day as I strive to develop new, more effective ways of teaching skin cancer prevention.

Generally, I prefer not to use scare tactics; rather utilize the personal touch and focus on real people, their emotions, their values, and their relationships. Hence, I share the stories of real people who have suffered melanoma and their personal battles with this horrible, devastating (yet PREVENTABLE) cancer.

However, I remember how the pictures of disfigured melanoma patients dramatically affected one particular young woman during a skin cancer prevention I hosted with Dr. Glen Bowen of Huntsman Cancer Institute last year –

As a former pageant girl, I invited the then Miss Utah Julia Bachison (a good friend of my co-founder, Natalie Johnson-Hatch, also a former Miss Utah) to be our Mistress of Ceremony; our event hostess. In addition to giving a presentation on skin cancer, we also celebrating the passing of a piece of legislation regarding sun safety education here in Utah, and wanted the "Queen of Utah” to kick off our event. Julia was gracious enough to stay for the entire event and listen to Dr. Bowen's presentation on skin cancer -- a presentation that squelched any desire she had to use a tanning bed again. Dr. Bowen's presentation featured pictures of patients who, because of skin cancer, suffered severe disfiguration. Many of these patients used tanning beds and the cumulative of ultraviolet radiation led to a battle with skin cancer. One patient lost an eye due to ocular melanoma. It broke my heart to know that so many of these people could have avoided a brush with melanoma, if only they knew about proper sun safety, the dangers of tanning, and the importance of dermatologic health. Julia, on the other hand, reacted somewhat differently to these "graphic" photos. She shuttered and gasped at the sight of these patients, even buried her face into my shoulder and vowed "I will never use a tanning bed again!" Julia was scheduled to compete at Miss America the following week, where the golden bronze look is coveted. Yet, Julia chose to follow in the footsteps of her friend and mentor - her favorite Miss Utah Natalie Camille Johnson the Skin Cancer Crusader who went to Miss America without tan. Julia did sport the bronze courtesy of a sunless tanning mousse, not a tanning bed, and won the preliminary Lifestyles and Fitness Award. The images of real people suffering from a real disease - PREVENTABLE cancer - had a profound and lasting effect on Julia. She was convinced that tanning is, in fact, dangerous; she realized that it is certainly not worth sporting a so-called "healthy glow" to put herself at risk for cancer. As Julia put it:

"It is ultimately self-defeating. You're tanning to look good, but it can later cause premature aging and, if you're diagnosed with skin cancer it can cause severe disfiguration and even kill you!"

And that's the bottom-line. Tanning does increase one's risk for melanoma skin cancer and melanoma can – and does – kill. In fact, melanoma kills another person in the U.S. every hour.

BUT IT IS PREVENTABLE!!!

Sometimes I feel like a broken record, but it is important to emphasize and re-emphasize that skin cancer is PREVENTABLE. Personally, my stream of logic is: If you can eliminate (or significantly reduce) your risk for cancer than by all means do it, especially when the preventative measures are as simple as: AVOIDING TANNING BEDS, along with monthly self-skin exams; annual visits to the dermatologist; regular (and proper) daily use of sunscreens throughout your life all-year-round; wearing UV protective wrap-around sunglasses, wide-brimmed hats, and protective clothing.

Is it that it's just too simple? Or is it the media inundating us with misinformation, misnomers and myths, and other mixed messages that has created a lingering cloud of confusion and disillusionment, thus making light of a very serious – and growing – issue? If so, may I suggest that youth who remain undeterred in their quest for coveted bronze-skin, to consider the source of the information you hear regarding tanning. Your board-certified dermatologist who went to medical school will tell you that there is no such thing as a safe tan. Yet, the tanning industry will use phrases such as "tanning in moderation" or "tan responsibly", which are minor attempts at issuing warnings without admitting the dangers outright. The only way to tan responsibly is to NOT TAN! Tanning beds are not viable tool for treating acne or Seasonal Affective Disorder, or any other condition. They are dangerous. The cumulative effects can lead to melanoma. So, why risk it? If simply must heed to your inner desire to surrender to the unrelenting pressure to look like Lindsey Lohan, then use a quality sunless tanning mousse - it won't cause premature aging and it certainly won't put you at risk for a lethal skin cancer.

Occasionally, I will receive an email from someone who accuses of me of being antagonistic toward the indoor tanning industry. And if I have been antagonistic, I apologize. Let us not fight fire with fire. If we attempt to fight extinguish a grease fire with water, we will only get burnt. (No pun intended).

I will never forget an email I received three years ago, from a tanning salon owner, who highlighted an excerpt from a newspaper article featuring my dear friend/co-founder's brother who, at age 21, succumbed to complications associated with a malignant melanoma. In the email they said, "The doctors killed him not the melanoma". In an attempt to deter me from discussing the dangers of tanning, I was heartbroken to read those malicious words but I was swayed; rather I was reminded that I have a great deal of work to do with regard to skin cancer prevention education. We all do.

In truth, this is not about playing sides or making anyone look bad; to attack the indoor tanning industry. This is not about hampering or hindering one's ability to make a living and run a successful business. I'm a big proponent of the entrepreneurial spirit. [Yet,]I'm an even bigger proponent of protecting and serving people; improving their overall quality of live. As the Hippocratic oath states "o practice and prescribe to the best of my ability for the good of my patients, and to try to avoid harming them" I will do what I can to help protect people, especially youth, from a preventable cancer. I’m not a doctor, but I am fiercely loyal to the dermatologists who strive all day, every day to protect their patients from skin cancer, and I remain dedicated to teaching people about it. Part of the rent I pay here on this earth is to serve others and this is one of the ways I try to serve. May I serve well, God-willing, and perhaps touch someone's life for the good.

Yours in the fight against skin cancer,
Danielle