Appearance may only be skin deep but society has always judged us by that whether we like it or not. Social pressure to ‘enhance’ skin pigmentation has driven some fair-skinned individuals to engage in risky and unhealthy behaviors, such as with the alarming trend of increased UVA-rich sunlamp use by young women over the last 20–30 years. Not surprisingly, younger generations have ignored public health warnings in favor of extending their potentially carcinogenic exposure to UV. Of concern is the lack of a strong public health policy to protect vulnerable adolescents who receive careless intermittent sunburns from artificial sources of UV. Emerging data on the incidence rates of skin cancers in young women under the age of 40 compared to men of that age group suggest that their etiology is due, at least in part, to excessive repeated intermittent exposures to unnaturally large amounts of UVA from UVA-rich sunlamps. Regrettably, much of this excessive UV exposure is preventable, but public health officials, physicians and parents continually underestimate the use of sunlamps by adolescents in the same way that other risky behaviors in our society were once dismissed, e.g. smoking.
Those who argue against the correlation between sunlamps and the increased risk of melanoma and other types of skin cancers typically state that one cannot readily separate sunlamp exposure from normal solar exposure. Although this argument has some validity, the contribution of sunlamps should not be minimized. There is overwhelming evidence that UV is the cause of nonmelanoma skin cancers so the argument to have additional sources of UV exposure (not administered by medical personnel) other than the sun is a disservice to public health. Obviously, UV is a ubiquitous carcinogen, having both harmful and beneficial effects. UV is impossible to avoid completely, but exercising intelligent levels of exposure is critical to minimizing erythema, immune suppression, photoaging and skin cancer. The deleterious effects of UV have been known for a long time, but it is only in recent decades that artificial sources of UV have become available that contribute to the etiology of skin cancer. Our skin has protected us for millennia from the environment, but it is particularly vulnerable to increased exposure to UVA that can penetrate much deeper into the skin.
The unnaturally high UVA doses provided by UVA-rich sunlamps (which are now predominantly used in the tanning industry) are particularly deceiving to young adolescents because they are being promoted as ‘damage-free’ tans yet recent studies show that UVA offers no protective effects from further UV exposure and is not risk-free. Furthermore, the justification for sunlamp use to increase vitamin D levels in a young population that lacks rickets and has access to dietary vitamin D supplementation further underscores the fact that unnecessary additional UV exposure poses a preventable risk.
We hypothesize that the increasing incidence of melanomas, particularly in young women, reflects their increased intermittent use of UVA-rich sunlamps with increased annual UV doses and stronger dose rates compared to solar exposure. In the following sections, we provide evidence in the literature that strengthens this hypothesis.