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Indoor tanning slightly increases risk of nonmelanoma skin cancers

Clinical Question:
Is tanning bed (sunbed) use associated with the development of nonmelanoma skin cancer?

Bottom Line:
The risk of nonmelanoma skin cancers seems to be increased among users of indoor tanning beds. The method of melanin-making in indoor tanning -- short bursts of high intensity -- may be the cause, or the use of indoor tanning may simply identify people who do more tanning in general. (LOE = 2b)

Reference:
Wehner MR, Shive ML, Chren MM, Han J, Qureshi AA, Linos E. Indoor tanning and non-melanoma skin cancer: systematic review and meta-analysis. BMJ 2012;345:e5909.  [PMID:23033409]

Study Design:
Meta-analysis (other)

Funding:
Government

Setting:
Outpatient (any)

Synopsis:
In a somewhat breathless introduction, the authors of this meta-analysis characterize nonmelanoma skin cancer as an "epidemic," but then deflate their own balloon by pointing out that these skin cancers typically don't affect mortality. Still, there are financial, cosmetic, and other sequelae. The authors searched 3 databases for English-language studies that examined the relationship between past tanning bed use and the development of these skin cancers in people in the United States. Although not well-described in the paper, the included studies seem to be prospective and retrospective cohort studies. "Ever-users" of indoor tanning had a 67% increase in the likelihood of squamous cell cancer (relative risk [RR] = 1.67; 95% CI, 1.29 - 2.17) and a 29% increase in the likelihood of basal cell cancers (relative risk = 1.29; 1.08 - 1.53). The risk was slightly increased by the use of indoor tanning by prime users; ie, people younger than 25 years. Part of the increased risk attributed to indoor tanning may because tanners are more concerned about their skin in general and see dermatologists more often than the average person (see BMJ 2005;331:481). Indoor tanning could also simply be an marker for people who spend more time outdoors in the sun. A similar study found that the risk of melanoma was also slightly increased with indoor tanning (BMJ 2012;345:e4757).

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