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Susan Keown was a staff editor and writer at Fred Hutchinson Cancer Center from 2014-2022 who has written about health and research topics for a variety of research institutions. Find her on Twitter @sejkeown.
As the weather heats up and the sunny outdoors beckons, throw some knowledge about skin cancer into your beach bag along with your towel and flip flops.
This year, millions of Americans will get skin cancer, and thousands will die from it. But everyone can take steps to lower their risk.
Unfortunately, said skin cancer experts at Fred Hutchinson Cancer Research Center, myths about skin health abound — many of which are promoted by the multibillion-dollar tanning-salon industry.
Have you heard any of these skin-cancer untruths? Check your knowledge and protect yourself.
Tanning salons, tanning salons, tanning salons
Even with the summer sun in its full glory, the most dangerous myths on the minds of Fred Hutch experts right now involve indoor tanning. There are so many harmful myths floating around about tanning salons that it’s hard to know which ones to tackle first.
The Cliffs Notes version: Do not, under any circumstance, use a tanning bed or a tanning lamp. And if you already have, don’t use them any more.
“It’s so crazy that it’s legal for teenagers in most parts of the country,” said Fred Hutch melanoma researcher Dr. Sylvia Lee.
Let’s address some of the top tanning-industry lies individually:
Myth 1: Tanning beds are safer than the sun.
Actually, the opposite is true: Devices like tanning beds and sun lamps can emit higher amounts of ultraviolet radiation than the sun, including both UVA and UVB radiation. UV radiation of any type increases your cancer risk, and the more you get, the higher your risk.
“Tanning booths increase your risk of melanoma a ridiculous amount because they use really unnatural levels of UV light that you’re never exposed to in nature,” Lee said, referring to one of the most deadly types of skin cancer. Only 1 percent of people diagnosed each year with skin cancer have melanoma, according to the American Cancer Society, but it’s responsible for most skin cancer deaths.
A 2003 study of tanning facilities in North Carolina found that the average amount of UVA radiation emitted by the beds in the study was four times higher than what’s emitted by the noontime sun, and the average UVB radiation level was nearly twice as high as the sun. The study also found that patrons were commonly in the beds for far longer than U.S. Food and Drug Administration-recommended limits for exposure to such dangerously high radiation .
Myth 2: I can protect myself by getting a ‘base tan’ at a salon.
Tanning salons advertise that getting a “controlled” tan in a tanning bed at the beginning of the summer protects you by making it harder for you to burn when you go outside.
“That’s something that we see people being told all the time at skin-tanning parlors — that it’s healthy to get a ‘base tan,’” said Dr. John Thompson, who co-directs the Melanoma Clinic at Seattle Cancer Care Alliance, Fred Hutch’s clinical care partner. “That’s just complete baloney.”
The bottom line: “Tanning parlors actually give people UV radiation, which is harmful for their skin,” Thompson said. Ultraviolet light, no matter if you’re exposed indoors or out in the sun, damages your DNA in a way that can lead to the development of cancer. You don’t have to burn to damage your skin. A tan, no matter how it is acquired, is a sign of damage.
After UV damage, your skin protects itself by producing melanin — the pigment responsible for brown and black skin tones. However, most people don’t realize that the amount of protection conferred by melanin is tiny, said SCCA skin cancer physician Dr. Lee Cranmer.
“Even the darkest coloration of the skin with melanin only has an SPF [sun protection factor] equivalent to about 5,” Cranmer said. So, in comparison, the small amount of melanin that a fair-complexioned person would get as a result of a so-called base tan “isn’t really going to provide significant protection,” he said.
The best solution, Cranmer said: Use sun-blocking clothing and sunscreen, and avoid the sun from late morning until late afternoon. And never visit a tanning salon.
Myth 3: It’s OK as long as I’m not a frequent user of a tanning salon.
So you want to go to a tanning salon "just this one time" to get that sun-kissed look for a special event? Skip it, researchers say.
According to a systematic review of research by the International Agency for Research on Cancer, any use of a tanning bed before age 35 is associated with a 75 percent increase in risk for melanoma. The reviewers also identified an increased risk of squamous cell carcinoma, one of the most common types of skin cancer, from tanning bed use before one's mid-30s.
The increase in risk from even limited use of tanning beds is “so impressive and disturbing,” Lee said. “Each time is hugely damaging.”
Also, a growing body of evidence supports the idea that tanning has an addictive quality. Exposure to UV releases endorphins, the “pleasure chemical” of the human body that stimulates the brain’s reward center. But that rush can be dangerous.
“There are some people who are prone to addictive behavior who are prone to suntanning for the same reasons,” Cranmer said.
Other skin cancer myths
In addition to tanning salon myths, Fred Hutch experts highlighted other skin cancer fallacies:
Myth 4: I need to get out in the sun without sunscreen to get my vitamin D.
Many Americans are deficient in vitamin D, and certain groups — like older adults, obese people and people with dark skin — are at higher risk of a deficiency. And it’s true that UV exposure without the protection of sunscreen causes your skin to produce vitamin D. Vitamin D is important for promoting strong, healthy bones and has even been linked to lower risks of certain types of cancer.
But, Lee said, there are safer and more efficient ways of getting enough vitamin D: namely, taking vitamin D supplements and eating vitamin-fortified foods like some milk and cereal products.
According to the definitive 2010 report on vitamin D from the National Academies of Sciences, Engineering and Medicine, there is no research to support the idea that you can safely get vitamin D from UV light without also increasing your risk of developing skin cancer.
Myth 5: After a long, dark winter, it’s not so bad to enjoy a little bit of sun without sunscreen for once.
Fred Hutch is based in Seattle, a city famous for its seasonal gloom. And Seattleites can vouch: There is no sight as glorious after a dark and rainy Northwest winter as a sunny blue sky. On the first warm days of the year, we crawl out of our winter hiding places, burst out of our GoreTex exoskeletons and throw our exposed flesh into the welcome rays.
There’s nothing wrong with enjoying the sunshine, Lee said. But slap on that sunscreen first. Getting a sunburn, even infrequently, boosts your risk of melanoma.
“People don’t realize that sporadic sun exposure can really cause a lot of damage,” Lee said. “The problem is people very naturally feel like they haven’t seen sun all year, or they go on vacation to Hawaii or the Southwest, and they feel like they don’t really need sun protection. And they get fried.”
Myth 6: I’m definitely applying my sunscreen correctly.
Are you sure?
“It’s pretty common that people don’t apply it frequently enough,” Lee said. “I think it’s common that people just apply it early in the day, but it really should be applied every two hours if you’re out in the sun.”
The Centers for Disease Control and Prevention recommends applying a thick layer of a broad spectrum sunscreen (that is, one that protects against both UVA and UVB light) of at least SPF 15 before going outside, even on cloudy or cool days. Sunscreen should be reapplied after two hours in the sun or after swimming, sweating or using a towel.
Myth 7: Skin cancer is not that big of a deal.
It is true that the most common types of skin cancers are not as deadly as many other malignancies. According to the American Cancer Society, 8.7 million people are diagnosed with the two most common types of skin cancer each year — basal cell carcinoma and squamous cell carcinoma — and very few will die from these cancers. The U.S. records about 2,000 deaths from these two cancer types every year, according to the society. In comparison, the biggest cancer killer in the U.S. — lung cancer — takes the lives of more than 150,000 Americans a year.
However, Cranmer pointed out, while the most common skin cancers aren't as deadly as other malignancies, they can affect quality of life. Skin cancers “can have significant impact even if they don’t kill someone in terms of the destruction they cause,” he said. The costs are also significant.
And some types of skin cancers are more lethal, including melanoma, which more than one out of every 50 Americans will develop at some point in their lifetime, according to the National Cancer Institute.
In short, Cranmer emphasized, the best practice is just to take steps to prevent skin cancers and not run the risk.
Early detection and treatment also save lives from skin cancer, he added. Watch out for hallmark warning signs, including changes in a mole’s size or color, bleeding or itching.
“When someone around you tells you, ‘You should have that checked out,’ they’re probably right,” Cranmer said.
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