How to prevent skin cancer in tanning beds

Anyone can get skin cancer, but the Centers for Disease Control and Prevention (CDC) outlines several characteristics that can put people at a greater risk: (1)

• Lighter natural skin color
• Skin that burns, freckles, reddens easily, or becomes painful in the sun
• Blue or green eyes
• Blond or red hair
• Certain types of moles or a large number of moles
• A family or personal history of skin cancer
• Older age

Dawn Holman, MPH, a behavioral scientist in epidemiology and applied research at the CDC, stresses that even though risk factors are higher in people with fair skin, people with all skin types are susceptible to skin cancer and can benefit from sun protection and staying alert to changes in their skin.

Sun Exposure: The Electromagnetic Spectrum

Most often, ultraviolet (UV) light is at the center of conversations around skin cancer, because it is the No. 1 cause of skin cancer.

Electromagnetic radiation comes in wavelengths of light. Only some are visible to the human eye, and wavelengths along the electromagnetic spectrum affect the skin in different ways. (2)

UVB Shortwave ultraviolet B rays cause sunburns and damage the DNA in skin cells, which can ultimately lead to skin cancer. UVB rays are a tiny portion of the electromagnetic spectrum, but they are traditionally where most sunscreen companies focus their attention. (2)

UVA Long-wave ultraviolet A rays result in tanning and premature signs of aging. UVA rays are prevalent in all kinds of weather and can even penetrate glass. (2) When researchers realized UVA rays also contribute to skin cancer, they developed broad-spectrum sunscreens to protect against it, too, with the added benefit of preventing wrinkles and dark spots.

Protecting against both UVA and UVB rays is an important part of skin cancer prevention. Mary Stevenson, MD, a professor of dermatology at NYU Langone Health in New York City, says broad-spectrum is a key phrase to look for when purchasing sunscreen because it protects against both UVA and UVB rays.

RELATED: 8 Moisturizers With Built-In SPF to Help Keep Your Skin Glowing and Sunburn-Free

Sun Protection and Skin Cancer Prevention Methods

Sun Avoidance

Dr. Stevenson says the best time to go outside is in the early morning or late afternoon when the sun isn’t as strong, or to stay primarily in the shade when possible. At other times of day, seek out shade. Some of Holman’s research at the CDC has drawn attention to the value of shade and its potential use in promoting sun protection through urban planning and design. She worked with an architect in Canada to study the benefits of incorporating shade into public and individual spaces, which include skin cancer prevention benefits.

Sunscreen

Sometimes going outside during hours when the sun is at its strongest is simply unavoidable. The American Cancer Society recommends using a broad-spectrum sunscreen with an SPF of at least 30 and suggests reapplying every two hours, as well as after swimming or sweating. (3)

Choosing a sunscreen can be challenging. In addition to seeking ingredients that support skin cancer prevention, it’s important that the act of wearing sunscreen isn’t a negative one, otherwise you’re less likely to use it.

Many sunscreens have chalky textures or leave white residue, which can make wearing it unpleasant for Black people and other people of color. The experience of wearing sunscreen was top of mind for the entrepreneur Shontay Lundy when she founded her brand, Black Girl Sunscreen.

“It’s the No. 1 reason why women of color aren’t wearing sunscreen,” says Lundy. “Back in 2016 when we launched, most sunscreens didn’t address this issue.”

Black Girl Sunscreen is broad-spectrum, SPF 30, and dries completely clear, eliminating the chalky white sheen that other sunscreens can leave behind. Lundy and the Black Girl Sunscreen team have also partnered with melanoma organizations to help educate and advocate for skin cancer prevention.

There are just a few biologically active ingredients available to any sunscreen brand, so Lundy says it’s the inactive ingredient list where companies can differentiate and tell a story.

Lundy incorporates inactive ingredients into her formula, such as avocado, jojoba, carrot juice, and sunflower oil, to moisturize skin in addition to protecting it.

“We want to make it clear that our consumer was never an afterthought,” says Lundy. “They were always at the forefront.”

In a 2020 review, Consumer Reports recommended the following brands for their ability to block rays without leaving a chalky residue on dark skin: Banana Boat Simply Protect Sport Spray SPF 50, Hawaiian Tropic Sheer Touch Ultra Radiance Lotion SPF 30, and Hawaiian Tropic Island Sport Ultra Light Spray SPF 30.  

In addition to sunscreen and seeking shade, clothing coverage — such as a wide-brimmed hat and sunglasses that block at least 99 percent of UV light — are recommended when in the sun. (3)

Avoiding Tanning Beds and Sunlamps

There is a large amount of data linking artificial tanning to skin cancer, according to the American Academy of Dermatology Association: (4)

• It’s estimated that indoor tanning may cause upward of 400,000 cases of skin cancer in the United States each year.
• Higher melanoma rates among young females compared with young males may be due in part to widespread use of indoor tanning among females.
• Even one indoor tanning session can increase a user’s risk of developing melanoma by 20 percent, squamous cell carcinoma by 67 percent, and basal cell carcinoma by 29 percent.

Oral Preventative

Research published in the journal American Health and Drug Benefits found that the vitamin B3 supplement called nicotinamide can be helpful in preventing non-melanoma skin cancers when taken long term.

RELATED: 10 Sun-Care Products That Dermatologists Use

Sun Protection Misconceptions and Beliefs

Skin cancer research and prevention organizations have worked hard for years to eliminate false and misinterpreted information about the sun, vitamin D, and sunscreen.

For instance, Holman’s research found that many people believe they can’t get enough vitamin D from their diet alone, but those who do believe they’re getting an adequate amount from dietary sources are more likely to use sun protection. The same CDC study found that overall, almost 20 percent of adults believed that sun protection would put them at risk of not getting enough vitamin D.

Lundy has heard misconceptions that Black Americans can’t get skin cancer, don’t get sunburns, and generally don’t have to pay as much attention to sun protection as people with lighter skin. While all types of skin cancer are less common in people of color, outcomes are dramatically worse. (5) One study found an average five-year melanoma survival rate of 65 percent in Black Americans versus 91 percent in white people. Another showed that late-stage melanoma diagnoses are more common in Hispanic and Black patients than in non-Hispanic white patients. (5). Melanin does confer some natural protection against the risk of skin cancers from UV light, but people of any complexion are at risk for sun-related skin cancers. (5)

Mark Lebwohl, MD, a professor of dermatology at the Ichan School of Medicine at Mount Sinai in New York City, has heard a fair amount of misinformation around sunscreen, including that some sunscreens (particularly chemical sunscreens) are unhealthy.

“There’s not one iota of evidence other than a rare allergy that a single person has ever been harmed by sunscreen,” says Dr. Lebwohl. “There is a ton of evidence that patients have been helped by sunscreen.”

Lebwohl says another misconception is that older people with skin cancers related to sun exposure from many years ago no longer have to worry about their skin in the sun, which is false. Later in life, cells in your skin still fight against the development and progression of skin cancers, and sunlight knocks those cells out. Therefore, excessive exposure as you age can be a “double whammy,” Lebwohl says, as sun can eliminate cells protecting the cells damaged from decades earlier.

RELATED: What Is the Recommended Intake of Vitamin D?

Types of Skin Cancer

Skin cancer is the most common cancer in the United States, with basal cell carcinoma being the most common subtype. (4,6) The main types of skin cancer are basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma. There are also a handful of rare skin cancers including Merkel cell carcinoma, which is very aggressive. (6)

Basal Cell Carcinoma BCC is defined as abnormal, uncontrolled growths that arise from the skin’s basal cells in the epidermis — the outermost layer of skin. Most cases are caused by a combination of intermittent intense exposure and cumulative, long-term exposure to UV rays. (6)

Therapies currently used to treat basal cell are very effective, with an 85 to 95 percent recurrence-free cure rate, meaning the area of skin treated is effectively cured after the first round of treatment. (7)

Anthony M. Rossi, MD, a dermatologic surgeon at Memorial Sloan Kettering Cancer Center in New York City, says BCC is often confused for a pimple that won’t heal or go away, but how basal cell carcinoma looks can vary. He says warning signs include an area of skin that’s red, crusted, scaly, not healing, or bleeding, or even a new shiny pearly papule.

Squamous Cell Carcinoma SCC develops from an uncontrolled growth of abnormal cells arising from the squamous cells in the epidermis. Squamous cell carcinoma is the second most common type of skin cancer and is caused by UV radiation from the sun and tanning beds. (7)

Like BCC, it’s most common in sun-exposed areas of the skin like the ears, face, scalp, neck, and hands. (6) It can appear as a firm, red nodule or a flat lesion with a scaly, crusted surface. (8) SCC has a higher risk than BCC of spreading elsewhere in the body.

Melanoma Melanoma is the deadliest of skin cancers and one of the most common cancers found among young adults in the United States, according to the Melanoma Research Alliance. (9) According to the CDC, the incidence of melanoma has doubled over the past three decades in the United States. (10)

It develops from melanocytes, the skin cells that produce melanin pigment, which gives skin its color. (6) Dr. Rossi says melanoma can form from pre-existing moles on the body, though it most commonly develops as a new lesion on the skin.

Signs of melanoma include a large brownish spot with darker speckles; a mole changing in color, size, or feel; or a lesion that bleeds or has an irregular border with portions that appear red, pink, white, blue, or blue-black. It can also be a painful lesion that itches or burns. (8)

Catching and treating melanoma early is key for recovery. It’s one of the reasons skin checks and a relationship with a dermatologist is so important.

If someone has already had melanoma, the risk of recurrence is higher, as is the risk for developing new melanomas. People who’ve had BCC or SCC are also more likely to develop melanoma. (11)

For all stages of melanoma, the average five-year survival rate in the United States is 92 percent. For patients whose melanoma is detected early, it rises to 99 percent. The survival rate falls to 65 percent when the disease reaches the lymph nodes, and 25 percent when the disease metastasizes to other organs. (12)

RELATED: Beating the Odds Against Merkel Cell Carcinoma

Skin Cancer Treatment

An individual’s best treatment options depend on several factors, including the type of skin cancer, the size and location of the tumor, and the patient’s age, general health, and preferences.

Treatment may be one method or a combination of surgery, radiation therapy, immune response modifiers, photodynamic therapy, topical chemotherapy, cryotherapy, or medication that can shrink or slow tumor growth. (13)

Typical treatments for basal cell carcinoma and squamous cell carcinoma include minor surgeries and other local treatments. Surgery is usually the main treatment for early-stage melanoma. (14)

There are different types of surgery, but Mohs micrographic surgery is popular because of its real-time accuracy. It has the highest cure rate of all therapies and is especially effective for high-risk BCC. (15)

“With Mohs micrographic surgery, the dermatologist acts as both the surgeon and the pathologist,” says Rossi. “You’re actually examining all the margins and looking at it in real time, whereas in a traditional excision, the surgeon removes the tissue and sends it to a pathologist and they examine only a portion of the margin.”

For metastatic melanoma — cancer that has spread beyond its original location to other parts of the body — drug therapies are usually also part of the treatment plan. (13)

Editorial Sources and Fact-Checking

1. What Are the Risk Factors for Skin Cancer? Centers for Disease Control and Prevention. April 18, 2022.
2. Bain J. Innovations in Skin Protection, Part 1: Protecting Across a Broader Spectrum. Skin Cancer Foundation. June 4, 2020.
3. Simon S. Spend Time Outside and Stay Sun-Safe. American Cancer Society. April 15, 2020.
4. Indoor Tanning. American Academy of Dermatology. June 21, 2022.
5. Ask the Expert: Is There a Skin Cancer Crisis in People of Color? Skin Cancer Foundation. July 5, 2020.
6. Skin Cancer 101. Skin Cancer Foundation.
7. Basal Cell Carcinoma Survival Rate. Moffitt Cancer Center.
8. Skin Cancer. Mayo Clinic. December 5, 2020.
9. Melanoma Statistics. Melanoma Research Alliance.
10. Rates of New Melanomas — Deadly Skin Cancers — Have Doubled Over Last Three Decades. Centers for Disease Control and Prevention. June 2, 2015.
11. Melanoma Risk Factors. Skin Cancer Foundation. June 2021.
12. Cancer Facts and Figures 2020 [PDF]. American Cancer Society. 2020.
13. Basal and Squamous Cell Skin Cancer. American Cancer Society.
14. Melanoma Treatment. Memorial Sloan Kettering Cancer Center.
15. Basal Cell Carcinoma. Memorial Sloan Kettering Cancer Center.

Additional Sources

• Skin Cancer: Incidence Rates. American Academy of Dermatology. April 22, 2022.
• Holman DM, Berkowitz Z, Guy GP Jr., et al. The Association Between Beliefs About Vitamin D and Skin Cancer Risk-Related Behaviors. Preventative Medicine. June 2017.
• Starr P. Oral Nicotinamide Prevents Common Skin Cancers in High-Risk Patients, Reduces Costs. American Health & Drug Benefits. August 2015.

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