FROM THE ACADEMY Adverse effects of ultraviolet radiation from the use of indoor tanning equipment: Time to ban the tan Henry W. Lim, MD, a William D. James, MD, b Darrell S. Rigel, MD, c Mary E. Maloney, MD, d James M. Spencer, MD, MS, e and Reva Bhushan, PhD f Detroit, Michigan; Philadelphia, Pennsylvania; New York, New York; Worcester, Massachusetts; and Schaumburg, Illinois The incidence of melanoma skin cancer is increasing rapidly, particularly among young women in the United States. Numerous studies have documented an association between the use of indoor tanning devices and an increased risk of skin cancer, especially in young women. Studies have shown that ultraviolet exposure, even in the absence of erythema or burn, results in DNA damage. Countries and regulatory bodies worldwide have recognized the health risks associated with indoor tanning. In the United States, 32 states have passed legislation to regulate the indoor tanning industry, but there is an urgent need to restrict the use of indoor tanning devices at the federal level. The Food and Drug Administration is currently reviewing the classification of these devices. For all of these reasons, the Food and Drug Administration should prohibit the use of tanning devices by minors and reclassify tanning devices to at least class II to protect the public from the preventable cancers and other adverse effects caused by ultraviolet radiation from indoor tanning. ( J Am Acad Dermatol 10.1016/j.jaad.2010.11.032.) Key words: basal cell carcinoma; DNA damage; Food and Drug Administration reclassification of indoor tanning devices; immunosuppression; indoor tanning; legislation; melanoma; photoaging; photoderma- toses; radiation; regulation; skin cancer; squamous cell carcinoma; ultraviolet; ultraviolet A; ultraviolet B; vitamin D. T he incidence of melanoma and nonmela- noma skin cancer is increasing at a rapid rate, particularly among young women. 1,2 Melanoma is the most common form of cancer among young adults aged 25 to 29 years and the second most common cancer in those aged 15 to 29 years. 3 Numerous studies have documented the relationship between exposure to ultraviolet (UV) radiation and the development of melanoma and nonmelanoma skin cancers. 4-11 Specifically, UV ex- posure from indoor tanning devices has been shown to lead to an elevated risk of melanoma. The relative risk is even higher if tanning bed use begins before age 35 years. 12 In 2009, the World Health Organization catego- rized tanning beds as carcinogenic to human be- ings. 13 Multiple countries have recognized the danger posed by indoor tanning devices and have taken steps to restrict or even ban their use. Brazil has imposed a total ban on the use and sale of such devices. 14 France, Germany, Austria, and the United Kingdom have banned indoor tanning for individ- uals younger than 18 years, whereas South Australia From the Department of Dermatology, Henry Ford Hospital, Detroit a ; Department of Dermatology, University of Pennsylva- nia b ; Department of Dermatology, New York University c ; Divi- sion of Dermatology, University of Massachusetts Memorial Medical Center d ; Department of Dermatology, Mt Sinai School of Medicine, New York e ; and American Academy of Dermatol- ogy, Schaumburg. f Funding sources: None. Disclosure: Dr Lim served as consultant for LaRoche-Posay, Ofagen, and Dow Pharm Sciences, receiving honorarium, and as an investigator for Johnson and Johnson, receiving grants. Dr Rigel served as a consultant and on the Advisory Board for Beiersdorf, receiving honoraria and as consultant, investigator, speaker, and on the Advisory Board for Neutrogena, receiving honoraria. Dr Spencer has been on the Advisory Board for L’Oreal, receiving honoraria. Drs James, Maloney, and Bhushan disclosed no relevant conflicts of interest. Accepted for publication November 21, 2010. Reprint requests: Reva Bhushan, PhD, 930 E Woodfield Rd, Schaumburg, IL 60173. E-mail: rbhushan@aad.org. Published online February 2, 2011. 0190-9622/$36.00 ª 2010 by the American Academy of Dermatology, Inc. doi:10.1016/j.jaad.2010.11.032 Abbreviations used: BCC: basal cell carcinoma CDRH: Center for Devices and Radiological Health FDA: Food and Drug Administration IARC: International Agency for Research on Cancer SCC: squamous cell carcinoma UV: ultraviolet e1