From Skin Cancer Statistics and Issues

A tan is a sign of skin damage. Any method of tanning that involves exposure of the skin to ultraviolet (UV) radiation, either by sunlight or solarium, will cause skin damage. There is no such thing as a safe tan. Tanning is a photoprotective response to UV-induced DNA damage,[1] resulting in pigmentation darkening due to increased melanin in the epidermis.[2] In other words, when skin is over-exposed to UV radiation, more melanin is produced, thereby darkening the skin. A tan is a response to excessive UV exposure, and is therefore a sign that UV damage has occurred.

Although exposure to both UVA and UVB radiation can increase skin pigmentation, UVB is more effective at stimulating a tanning response compared with an equivalent UVA dosage. UVA-tanning appears to be due to a redistribution of melanin in the epidermis, while UVB exposure actually increases the amount of melanin produced.[3] UVA-induced tanning appears to be the result of melanin/melanin-precursor oxidation or redistribution of melanosomes (organelles containing melanin) to higher skin levels, while UVB-induced tanning involves increased melanin content (through increased re-uptake) and melanocyte differentiation (i.e. non-specialised cells acquiring the specialised features of a melanocyte).[3]

A tan only offers modest protection (SPF3) against sunburn[4] and although it is an adaptive response triggered by harmful UV exposure, the protection it offers against further DNA damage is not absolute and varies in efficiency, depending on skin type.[5][6] In an experiment where skin was irradiated with either UVA or UVB to induce a tan, subsequent exposure to an erythemal dose of UV showed that UVA tans confer no photo-protection, while UVB-induced tans are only minimally protective.[3] Furthermore, research has also shown that a false sense of protection from a baseline tan encourages individuals to increase their time in the sun, thereby increasing their chance of sunburn.[7]

There is research to show that regular tanning can become addictive. As UV light has biochemically reinforcing properties,[8] studies have shown some solarium users can experience withdrawal-like symptoms[9] and meet the criteria for addiction (DSM IV/DSM-IV-TR[8][10] and CAGE[10]). Furthermore, as frequent tanners are able to distinguish between ultraviolet and non-ultraviolet light,[8] there is likely a physiological as well as psychological component to tanning addiction.[11]

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Tanning trends

The findings from three national surveys during summers between 2003-04 and 2010-11 suggest there has been a reduction in Australians’ pro-tanning attitudes and behaviours. In 2010-11, fewer adolescents and adults desired a suntan, held beliefs that a suntan is healthy, and attempted a suntan than in summer 2003-04.[12] A fourth survey in 2013-14 found further decreases in the percentages of adolescents who desire and attempt a suntan.[13]

Table 1 Trends in adolescents’ and adults’ intentional tanning attitudes and behaviour [12]

2003-04 2006-07 2010-11 2013-14[13]
Adolescents (12 – 17), n= 3,779
Preference for a suntan 60% 51% 45% 38%
Believes a suntanned person is more healthy 19% 17% 12% 16%
Attempted a suntan this season* 32% 22% 22% 17%
Adults (18 – 69), n= 15,570
Preference for a suntan 39% 32% 27%
Believes a suntanned person is more healthy 14% 12% 10%
Attempted a suntan this season 15% 11% 9%

* Significant improvement evident only since 2003-04.

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Solarium tanning

Solariums emit harmful levels of UV radiation,[14][15][16][17] which contributes to increased skin cancer risk,[18][19] acute sunburn and blistering, photoageing, ocular diseases, and local and systemic immunosuppression.[20] They are banned for commercial use in all Australian states and territories.

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Fake tanning

Fake tanning products are lotions, creams, or sprays that simulate a suntan by dyeing the outer layer of skin, and do not include temporary bronzers or tinted powders.[21][22] Topical dyes are typically vegetable dyes that stain the skin a darker colour, while spray tans coat the skin in a fake tanning solution.

Fake tanning lotions may be safer alternatives to sun-tanning. However there is no consistent data to show that users of fake-tanning products are more compliant with sun protection in general.[23] A few tanning lotions include sunscreens, ranging from sun protection factors (SPF) 4 to 15. However, this protection only lasts for a short time following application and not for the duration of the fake tan. Promoting a tanning product as being protective against UV radiation may be misleading. All tanning products should be used in conjunction with the five sun protection measures – clothing, sunscreen, wide-brimmed hat, shade and sunglasses.

In the case of spray tanning, researchers studying cells in a lab in the US have expressed concerns over the potential inhaling of substances such as colour additive dihydroxyacetone (DHA).[24][25] There is no evidence that DHA is harmful when applied topically in a cream or lotion, and the potential risk during a spray tan can be mitigated with use of goggles and a face mask .[24]

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Tanning accelerators

Tanning accelerators/activators claim to stimulate the production of melanin (the pigment that is responsible for skin colour) in the body. Psoralen (an ingredient of bergamot oil) is the most common tanning accelerator. Use of tanning accelerators is not recommended as psoralen has been shown to be carcinogenic.[26] Further, several cases of dysplastic naevi and melanoma development have been associated with Melanotan® injection use,[27],[28] although there is currenlty no research that shows a causal relationship.[27] Further studies are required on the safety of these products.[26]

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  1. Gilchrest BA, Eller MS. DNA photodamage stimulates melanogenesis and other photoprotective responses. J Investig Dermatol Symp Proc 1999 Sep;4(1):35-40 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/10537005.
  2. Coelho SG, Choi W, Brenner M, Miyamura Y, Yamaguchi Y, Wolber R, et al. Short- and long-term effects of UV radiation on the pigmentation of human skin. J Investig Dermatol Symp Proc 2009 Aug;14(1):32-5 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19675550.
  3. 3.0 3.1 3.2 Miyamura Y, Coelho SG, Schlenz K, Batzer J, Smuda C, Choi W, et al. The deceptive nature of UVA tanning versus the modest protective effects of UVB tanning on human skin. Pigment Cell Melanoma Res 2011 Feb;24(1):136-47 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/20979596.
  4. Gange RW, Blackett AD, Matzinger EA, Sutherland BM, Kochevar IE. Comparative protection efficiency of UVA- and UVB-induced tans against erythema and formation of endonuclease-sensitive sites in DNA by UVB in human skin. J Invest Dermatol 1985 Oct;85(4):362-4 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/3840189.
  5. Raab WP. Photodamaged skin: a medical or a cosmetic concern? J Int Med Res 1990;18 Suppl 3:2C-7C Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/2227084.
  6. Liu JJ, Fisher DE. Lighting a path to pigmentation: mechanisms of MITF induction by UV. Pigment Cell Melanoma Res 2010 Dec;23(6):741-5 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/20973930.
  7. Dennis LK, Lowe JB. Does artificial UV use prior to spring break protect students from sunburns during spring break? Photodermatol Photoimmunol Photomed 2013 Jun;29(3):140-8 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/23651274.
  8. 8.0 8.1 8.2 Feldman SR, Liguori A, Kucenic M, Rapp SR, Fleischer AB Jr, Lang W, et al. Ultraviolet exposure is a reinforcing stimulus in frequent indoor tanners. J Am Acad Dermatol 2004 Jul;51(1):45-51 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/15243523.
  9. Kaur M, Liguori A, Lang W, Rapp SR, Fleischer AB Jr, Feldman SR. Induction of withdrawal-like symptoms in a small randomized, controlled trial of opioid blockade in frequent tanners. J Am Acad Dermatol 2006 Apr;54(4):709-11 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16546596.
  10. 10.0 10.1 Mosher CE, Danoff-Burg S. Addiction to indoor tanning: relation to anxiety, depression, and substance use. Arch Dermatol 2010 Apr;146(4):412-7 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/20404230.
  11. Nolan BV, Taylor SL, Liguori A, Feldman SR. Tanning as an addictive behavior: a literature review. Photodermatol Photoimmunol Photomed 2009 Feb;25(1):12-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19152511.
  12. 12.0 12.1 Volkov A, Dobbinson S, Wakefield M, Slevin T. Seven-year trends in sun protection and sunburn among Australian adolescents and adults. Aust N Z J Public Health 2013 Feb;37(1):63-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/23379808.
  13. 13.0 13.1 Cancer Council Australia. Teens tone down tanning 10 years on. Attitudes to tanning improve, but sun protection neglected. Media Release. Sydney, Australia; 2014 Nov 17.
  14. Standards Australia, Standards New Zealand. Australian/New Zealand Standard AS/NZS 2635 (Solaria for cosmetic purposes). Sydney, Australia; 2008.
  15. Gies P, Javorniczky J, Henderson S, McLennan A, Roy C, Lock J, et al. UVR emissions from solaria in Australia and implications for the regulation process. Photochem Photobiol 2011 Jan;87(1):184-90 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21091485.
  16. Health issues of ultraviolet tanning appliances used for cosmetic purposes. Health Phys 2003 Jan;84(1):119-27 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/12498524.
  17. Berwick M. Are tanning beds "safe"? Human studies of melanoma. Pigment Cell Melanoma Res 2008 Oct;21(5):517-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18821856.
  18. Boniol M, Autier P, Boyle P, Gandini S. Cutaneous melanoma attributable to sunbed use: systematic review and meta-analysis. BMJ 2012 Jul 24;345:e4757 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/22833605.
  19. Ferrucci LM, Cartmel B, Molinaro AM, Leffell DJ, Bale AE, Mayne ST. Indoor tanning and risk of early-onset basal cell carcinoma. J Am Acad Dermatol 2012 Oct;67(4):552-62 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/22153793.
  20. Gordon L, Hirst N. The health effects of using solaria and potential cost-effectiveness of enforcing solaria regulations in Australia. Queensland, Australia: Queensland Institute of Medical Research; 2007 [cited 2008 Jan 16] Available from: http://www.arpansa.gov.au/pubs/rhc/QIMR_solaria07.pdf.
  21. Pagoto SL, Schneider KL, Oleski J, Bodenlos JS, Merriam P, Ma Y. Design and methods for a cluster randomized trial of the Sunless Study: a skin cancer prevention intervention promoting sunless tanning among beach visitors. BMC Public Health 2009 Feb 5;9:50 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19196482.
  22. Day AK, Oxlad M, Roberts RM. Predictors of sun-related behaviors among young women: comparisons between outdoor tanners, fake tanners, and tan avoiders. J Am Coll Health 2013;61(6):315-22 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/23930746.
  23. Girgis A, Tzelepis F, Paul CL, Walsh RA, McElduff P, McKenzie J. Australians' use of fake tanning lotions: another piece of the puzzle. Aust N Z J Public Health 2003 Oct;27(5):529-32 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/14651400.
  24. 24.0 24.1 United States of America Food and Drug Administration. Sunless Tanners and Bronzers. [homepage on the internet] USA; 2012 [cited 2012 Oct 5]. Available from: http://www.fda.gov/cosmetics/productsingredients/products/ucm134064.htm.
  25. Petersen AB, Wulf HC, Gniadecki R, Gajkowska B. Dihydroxyacetone, the active browning ingredient in sunless tanning lotions, induces DNA damage, cell-cycle block and apoptosis in cultured HaCaT keratinocytes. Mutat Res 2004 Jun 13;560(2):173-86 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/15157655.
  26. 26.0 26.1 Autier P, Doré J-F, Césarini J-P, Epidemiology ft, Prevention Subgroup EMCG, Boyle P et al. Should subjects who used psoralen suntan activators be screened for melanoma? Annals of Oncology 1997;8(5): 435-7.
  27. 27.0 27.1 Ong S, Bowling J. Melanotan-associated melanoma in situ. Australas J Dermatol 2012 Nov;53(4):301-2 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/22724573.
  28. Reid C, Fitzgerald T, Fabre A, Kirby B. Atypical melanocytic naevi following melanotan injection. Ir Med J 2013 May;106(5):148-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/23914578.

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