The Skin Cancer Foundation Journal

MAY 2012

The 2012 edition of The Skin Cancer Foundation Journal features medically reviewed, reader-friendly articles such as tanning, the increasing incidence of skin cancer diagnoses among young women, & the prevalence of melanoma among white males over 50.

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LIFESTYLE HOOKED ARIANNE S. KOUROSH, MD, AND HEIDI JACOBE, MD, MSCS D ecades of research and hun- dreds of thousands of skin cancer-related deaths have demonstrated that there is no such thing as a "healthy tan." Despite increased public awareness of the link between skin cancer and ultraviolet radiation (UV) from both the sun and tanning beds, relatively few tanners have converted to non-UV options. Nor has the increasing number of sunless tanning products available significantly reduced UV tanning. Why not? A growing body of research indicates that for frequent tanners, a direct effect on mood may be moti- vating many people to lie in the sun or in a tanning bed. As with people who need a drink or a cigarette, some tanners' feelings of elation and relief may eclipse their awareness of the threat of skin cancer and premature skin aging.1 question: are the effects of tanning more than skin deep? A TANNING EPIDEMIC In the US, where the lifetime risk of developing invasive melanoma has risen to 1 in 51,2 38 industry.3 Despite recent efforts to educate the public and limit young peoples' access to indoor tanning facilities, sunbathing and indoor tan- ning have not significantly decreased. Indoor tanners display a high level of knowledge about the risks of UV exposure, but this awareness does not alter tanning behavior, especially for those in their teens and twenties.4,5,6,7 Even among melanoma-prone fami- lies, 35 percent of young adults have reported using tanning beds.8 By persisting in such behavior, tanners resemble persons with substance dependence disorders. This research raises the 30 million Americans visit indoor tanning salons annually, fueling a $5 billion dollar a year TANNING DEPENDENCE Researchers have developed criteria to diagnose UV light-related substance abuse based on the classic CAGE questionnaire and the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV). CAGE was originally created to help identify alcohol abuse; it stands for Cut Down, Annoyed, Guilty, and Eye-opener. In studies, tanners were asked if they ever felt they needed to cut down on tanning; were annoyed by criticism about their tanning; felt guilty about tanning, or needed to tan first thing in the morning. In one investigation, 70 percent of frequent UV tanners met criteria for UV light substance abuse or dependence disorders.9 Subjects have reported missing events to tan, facing social or occupational consequences because of tanning, and continuing to tan despite awareness of its threat to their health.10,11 As with other addictive behaviors (like smoking), the younger tanners are when behavior begins, and the more frequently they tan, the greater the likelihood of dependence.12,13 There is also evidence that some frequent tanners are self-medicating underlying psychiatric disorders. Some researchers believe excessive tanning may be a form of body dysmorphic disorder (BDD),14 with the skin being the subject of the disorder. (Body dysmorphic disorder is a "preoccupa- tion with a specific body part and the belief that this body part is deformed or defective. The preoccupation causes distress or significant impairment in functioning."15 ) Repeated or excessive plastic surgery, for example, is a symptom of BDD. While a desire to look tan may con- tribute to some disordered (extreme) SK IN CANCER FOUNDAT ION JOURNA L ON TANNING Why You Shouldn't Start

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