For the first time, the U.S. Surgeon General is publicly focusing on skin cancer, urging Americans to take preventative measures like wearing sunscreen and staying in the shade when outdoors.

For the first time, the U.S. Surgeon General is publicly focusing on skin cancer, urging Americans to take preventative measures like wearing sunscreen and staying in the shade when outdoors.
However, a call to restrict the use of indoor tanning devices to minors has some businesses raising questions and concerns.
In McPherson, Shimmerz Tanning Salon, CT Fit 24 and Genesis Health Clubs offer indoor tanning to patrons in McPherson. Chuck and Taryn Vetter, owners of CT Fit 24, said they question whether it’s fair to single out indoor tanning, especially when people may not be using tanning beds correctly.
“There are other lifestyle choices that could be causing it,” Chuck Vetter said. “People might spend too much time in the sun or go to multiple tanning salons. That kind of thing is crazy, but how are we supposed to control that?”
According to the American Academy of Dermatology, more than 1 million people in the United States tan in tanning salons on an average day. The majority of tanners are Caucasian women and girls, primarily between 16 and 29 years old, and 35 percent of American adults, 59 percent of college students, and 17 percent of teens have reported using a tanning bed in their lifetime.
Boris D. Lushniak, acting U.S. Surgeon General, issued the call to action July 29. Although the call recognizes genetic factors such as fair skin and family history, it states the most common forms of skin cancer are linked to exposure to UV radiation, and this exposure is the most preventable cause of skin cancer.
In an interview with the Washington Post, Lushniak said the number of cases of melanoma, the most deadly form of skin cancer, has tripled in the last 30 years. There are 63,000 new cases of melanoma diagnosed each year, and an estimated 9,000 annual deaths from the disease, many of them involving teens and young adults.
However, Lushniak said in that interview it’s not clear what is causing the increase.
“The question is, is it based upon ultraviolet exposure? Increased outdoor activities? The indoor tanning industry and artificial sources of ultraviolet radiation? From our perspective, the real concern is that this is an increase, and we need to do something about it,” Lushniak told the Washington Post. “From the epidemiological surveillance perspective, we see the numbers increasing. But in terms of looking at specific [causes] of that, it’s still difficult to determine.”

A necessary risk
Although UV rays have been linked to skin cancer, they also play an important part in helping humans stay healthy. Vitamin D, which can be produced in the body with sunlight, helps the body absorb nutrients like calcium, iron, magnesium, phosphate and zinc.
According to the National Institutes of Health, very few foods in nature contain vitamin D, the best sources being the flesh of fatty fish, such as salmon, tuna, and mackerel, and fish liver oils. Small amounts of vitamin D are found in beef liver, cheese and egg yolks, as well as some mushrooms.
Foods fortified with vitamin D, such as milk, breakfast cereals and some brands of orange juice, yogurt and margarine, are the primary source of dietary vitamin D. Dietary supplements also can provide vitamin D.
The body can produce vitamin D from cholesterol when exposed to UV-B rays. Season, time of day, length of day, cloud cover, smog, skin melanin content, and sunscreen are among the factors that affect UV radiation exposure and vitamin D production.
A deficiency of vitamin D is associated with soft bones and skeletal deformities.
Indoor tanning exposes the body to UV-B rays, thus promoting vitamin D production.
“God made us with a need for vitamin D, and very little is in food,” Chuck Vetter said. “To go totally without exposure or slather your body in chemicals makes no sense to me.”
The Centers for Disease Control does not consider indoor tanning a safe way to obtain vitamin D and recommends getting the nutrient through food, as tanned skin indicates damage. It also states that indoor and outdoor tanning come with similar risks.
UV-B radiation also can be used to treat skin conditions like psoriasis. Called “light therapy” or “red light therapy,” this process involves exposing affected skin to UV-B rays, which suppress the immune system to reduce the inflammatory response in people with psoriasis.
Many new tanning beds can administer light therapy. Both CT Fit 24 and Shimmerz Tanning Salon offer light therapy to patrons.
“Some doctors will prescribe it for skin conditions like eczema,” said Lynette Minns, owner of Shimmerz Tanning Salon. “I’ve been prescribed to use it because my vitamin D is low.”
Some people use tanning to combat seasonal affective disorder, which can cause depression symptoms in winter, when light is scarce. Though they do not promote this use of tanning beds, the Vetters say some clients report feeling better after tanning.
“We have a lot of customers say they feel better, especially in winter, with exposure to light,” Chuck Vetter said.

Use as directed
Despite tanning’s benefits, the Vetters and Minns acknowledge there are risks associated with tanning, especially if used improperly.
“You can overexpose yourself, just like water or food,” Chuck Vetter said. “Water is necessary, but dangerous. If you expose yourself too much to UV rays, you’re going to damage your skin.”
Tanning beds have a maximum limit for how long a person should stay inside. The time varies based on the bed’s intensity, but the average is 20 minutes.
“Like anything else, it’s moderation,” Minns said.
At Shimmerz, patrons younger than 18 need parent permission, and patrons younger than 16 have to have a parent on site.
The Vetters take safety a step further by screening potential clients and turning away those who might be at a high risk for negative effects.
“Some people don’t tan and need to be careful with exposure to UV rays,” Chuck Vetter said. “If you don’t tan in the sun, you won’t tan in a bed. We will turn people away if they have negative answers.”
The Vetters said they also enforce a slow progression with new tanners, only allowing them a short time in the bed on their first visits to avoid burning.
“We follow what's called the ‘Smart Tan’ concept,” Taryn Vetter said. “We put folks in slow, three to four minutes, to bring melanin to the surface.”
Melanin is a pigment responsible for darkening skin and is produced in response to exposure to UV radiation.
According to the FDA, severe sunburns, especially at a young age, are linked to melanoma.
Exposure time is not the only safety precaution tanners should take. Failure to wear goggles can lead to eye injury, and certain medications and cosmetics can increase UV sensitivity, according to the FDA.
Despite their precautions, the Vetters say there’s only so much they can do, as they have no way of knowing how much exposure clients are getting outside or at other tanning locations.

Preventative measures
Lushniak’s call to action includes many suggestions, from increasing shade outdoors to education people about the risks associated with UV exposure. One proposal is for governments to adopt policies limiting access to indoor tanning beds, such as age restrictions for minors.
“We certainly know [indoor tanning] is something that’s become popular amongst youth,” Lushniak told the Washington Post. “And much like the surgeon general comes out very vehemently against youth smoking, I am coming out quite vehemently against youth exposing their skin to ultraviolet radiation in tanning booths.”
To date, nine states have already passed comprehensive laws that restrict minors’ use of tanning devices and many other states are considering similar legislation. Kansas does not ban tanning for minors.
Minns said she encourages people to talk to their doctors and doesn’t think the government should intrude.
“I think if there’s an issue, they need to talk to their doctor,” Minns said.