Observations: a student publication of the Lemke Journalism department, University of Arkansas, Fayetteville

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The Dark Side Of Tanning Is
A Dangerous And Deadly One
By Elizabeth McAlpine

Most people receive 80 percent of their lifetime exposure to the sun by 18 years of age. Unfortunately for students who tan, skin aging and cancer are delayed effects that usually don't show up for many years after the exposure. Since the damage is not immediately visible, young people are often unaware of the dangers of tanning. The sunburn you receive this week may take 20 years or more to become skin cancer.

You're back at school, gearing up for another long semester, and you head to the bookstore to do the mandatory wasting of a couple hundred bucks. You slowly take out your wallet and painfully hand over the money, hauling your heavy books off in a flimsy plastic bag. But wait, there is something in the bottom of the sack -- a new college coupon book for the semester. Your body tingles with excitement as you picture how many pizzas you will be able to buy for $6.99. But, the thrill dwindles when you see coupon after coupon offering deals on tanning packages.

Have we turned into a nation of pagan sun worshipers seeking out tanning altars to achieve a godlike bronze glow? Probably not, but why are college kids so targeted by these salons and why is tanning so popular with students?

Jessica Raney, student and employee of Sansole Tanning Salon, believes college students are under a lot of pressure to look good.

"You now see college kids working out and being very concerned with the physical appearance of their body. Well, tanning just goes along with that. A tan makes you look healthy and looks good with clothes."

Trisha Copher of Ann's Tann'In believes there might be a different reason.

"I see a lot of college students tanning before Spring Break so that they will look good on the beach. I also notice a lot of tanning for formals or big parties."

Whatever the case may be, many University of Arkansas students flock daily to one of the 30 local salons.

Marsha Beck, owner of Premiere Tans in Fayetteville, said about 75 percent of her customers are between the ages of 19 and 22.

The American Academy of Dermatology estimates that 3.8 million young adults and teenagers use tanning booths or sunlamps to tan every day. People are motivated to tan in salons by a few different reasons. Tanning is accomplished in less time, a tan is attractive and appealing, harsh burning is avoided and salons are generally sanitary and relaxing.

"Frankly, you just look better with color than you do if you are pasty white," Beck said.

Until the 1920s and 1930s, the fashion among the upper classes was to have porcelain pale skin. Fashionable

items of clothing were long skirts, sun bonnets and parasols. A tanned skin indicated that one had to work outside to earn a living, rather than employ servants. After the World War I, women discovered outdoor sports and exercise. Fashions changed and skin previously hidden was exposed. The resulting suntan was seen as an attractive and cosmetically desirable fashion accessory. It was not until the early 1950s that doctors associated sun exposure with skin cancer.

Most people receive 80 percent of their lifetime exposure to the sun by 18 years of age. Unfortunately for students who tan, skin aging and cancer are delayed effects that usually don't show up for many years after the exposure. Since the damage is not immediately visible, young people are often unaware of the dangers of tanning. It is difficult to persuade this age group that a suntan is not necessarily desirable. Skin cancer is very slow to develop. The sunburn you receive this week may take 20 years or more to become skin cancer.

Physicians and scientists are especially concerned that cases of skin cancer will continue to increase as people who are now in their teens and twenties reach middle age.

The skin is the body's largest organ. The skin is very important because it protects the body against heat, light, infection, injury, dehydration and aids in disposing of bodily wastes. Tanning is the skin's response to ultraviolet (UV) light. It is a protective reaction to prevent further injury to your skin from the sun. However, it does not prevent skin cancer. Skin cancer strikes more people worldwide than any other form of cancer. Every year more than one million people are diagnosed with skin cancer in the United States, according to the Centers for Disease Control and Prevention. Despite this fact, hundreds of thousands of people routinely visit tanning salons. The main cause of skin cancer is UV radiation from the sun. The sun emits light, infrared and ultraviolet rays. Ultraviolet rays are invisible, but they can pass deep into the skin.

What Is Skin Cancer?
Cancer is a general term used to describe various groups of diseases characterized by abnormal cell growth in the body. Skin cancer is a malignant tumor that grows in the skin cells. It is a disease in which cancer (malignant) cells are found in the outer layers of your skin. It is estimated that one out of seven people in the United States will develop some form of cancer in their lifetime. One serious sunburn can increase the risk by as much as 50 percent. About 80 percent of skin cancers occur on the face, head or neck; another 10 percent occur on the other exposed areas of the body, such as the back of the hand.

Who Is At Risk?
Skin cancer can happen to anyone, however the greatest risk is for people who:

Have fair skin.
Have blond, red or light brown hair.
Have green, blue or gray eyes.
Always burn before tanning.
Burn easily.
Don't tan easily and spend a lot of time outdoors.
Have been previously treated for skin cancer or have a family history of skin cancer.
Live in high altitudes (the thinner the atmosphere, the less UV rays are filtered).
Live in areas closer to the equator (where sun rays are strongest).
Work indoors all week and try to play "catch up" on the weekend.
Had early childhood sunburns.
Have certain types and quantities of moles.

Individuals who have had a skin cancer of any kind are at an increased risk of developing further skin cancers.

These people should think carefully about sun exposure and should seek shade when the sun is at its highest.

Those who tan in tanning salons should be aware of other considerations:

Those who burn easily or never tan in the sun should not use tanning salons.
Check with a pharmacist for possible drug interaction, especially with birth control and antihistamines.
UV radiation can aggravate cold sores in people who are prone to them.
Always use the protective goggles, which should be available at the tanning salon. Your eyes can be severely burned by the intense UV rays emitted by the light source. Studies show that too much exposure to ultraviolet rays can damage the retina. Over-exposure can burn the cornea, and repeated exposure over many years can change the structure of an eye lens so that it begins to cloud, forming a cataract. If left untreated this can result in blindness. The Food and Drug Administration requires tanning salons to direct all customers to wear protective goggles. Closing your eyes, wearing ordinary sunglasses or using cotton wads are not strong enough measures to protect the cornea from the intensity of UV radiation in tanning devices. Make sure the goggles fit snugly and that the salon sterilizes the goggles after each use to prevent the spread of eye infection.
Remember that skin exposed to UV lights remains cool to the touch and therefore you may not realize you are burned. In addition, the intensity of lights used in tanning devices is much greater than the intensity of UV rays in natural sunlight.

Skin Types and Skin Reactions to Ultraviolet Radiation
Dermatologists recommend you learn your skin type to safeguard yourself from the effects of the sun. People who are least sensitive to the sun have in their skin the greatest concentration of melanin, a brownish-black pigment that results in a tanned appearance.

Skin Type I

Always burns, sometimes painfully; seldom or never tans; peels; extremely sensitive to UV.
People with fair skin, blue or sometimes brown eyes, freckles, blond or red hair.

Skin Type II

Usually burns, sometimes painfully; sometimes tans, but not very much; may peel, very sensitive to UV.
People with fair skin, red, blonde or brown hair, and blue, hazel or brown eyes.

Skin Type III

Burns moderately; tans gradually; sensitive to UV.
Average Caucasian.

Skin Type IV

Seldom burns; tans easily and reacts with almost immediate darkening of skin; moderately sensitive to UV.
People with white, olive or light brown skin, dark brown hair and dark eyes.

Skin Type V

Almost never burns; tans easily and considerably; immediate darkening of skin; minimally sensitive to UV.
Brown-skinned people, often of Asian or Indian decent.

Skin Type VI

Never burns, but tans greatly; immediate darkening of skin; not sensitive to UV.
African-Americans.

Warning Signs of Skin Cancer
Early detection and treatment offers your best chance of remission and survival. Regular skin self-exams could save an estimated 4,500 lives annually. Anytime you are concerned about a growth or spot on your skin, it is best to seek the advice of your physician. If a mole or pigmented area does not look normal, your doctor will cut it out and look at it under the microscope to see if it contains cancer. Here are some signs that may indicate skin cancer:

A skin abnormality that increases in size and appears multicolored, pink, red, black, brown, tan, pearly, translucent or tan.
A mole that changes color, textures, grows, becomes irregular in shape, or that is bigger than a pencil eraser.
A spot or growth that continually itches, hurts, becomes crusty, scabs or bleeds.
An open sore that does not heal after four weeks or one that heals and reopens.
New moles-especially if it is a uniform bluish black or bluish gray or exhibits an uneven surface.

Types of Skin Cancer
Malignant or Cutaneous Melanoma, although more rare, is the deadliest form of skin cancer. It accounts for approximately 79 percent of all skin cancer deaths. This generally occurs in adults, but may occasionally be found in children and adolescents. Its incidence is rapidly rising in women under 40. Malignant melanoma starts in the melanocytes, skin cells that produce melanin pigment to color the skin. Malignant melanomas usually start out as moles that turn cancerous. This type of cancer is likely to spread through the lymph system or the blood. Men most often get melanoma on the trunk, head or neck; women most often get melanoma on the arms and legs.

Squamous cell carcinoma accounts for about 20 percent of all skin cancers. Although more aggressive than basal cell carcinoma, this cancer is highly treatable. Squamous cell carcinoma, which starts in the middle layer of the epidermis, looks like a red, scaly area of skin. Squamous cell carcinoma eventually becomes an open sore. These cancers grow relatively quickly and have potential to invade and destroy underlying structures and to spread to lymph glands and other parts of the body.

Basal cell carcinoma accounts for approximately 75 percent of all skin cancers, but it is highly treatable too. It starts in the basal cell layer of the epidermis and grows very slowly. In the beginning stages, basal carcinoma tumors look like small, shiny, raised bumps on the skin that occasionally bleed. Basal cell carcinoma does not spread as internal cancers do, but if left untreated it can badly damage and destroy underlying tissues.

Treatment for Skin Cancer
Treatment varies as determined by overall health and medical history, extent and type of the disease, tolerance for specific medications, procedures, or therapies, and expectations for the course of the disease.
Treatment may include:

Surgery to remove the skin cancer. This is normally the logical first step to try and rid the body of the cancer. Unless, the cancer has spread through the lymph nodes or the blood stream, this procedure is generally successful.
Radiation therapy -- the use of high-energy rays to kill cancer cells.
Chemotherapy -- the use of anticancer drugs
Biological therapy -- to help the body improve its own natural defenses against cancer
Photodynamic therapy -- uses a combination of laser light and drugs to kill cancer cells.

Protecting Your Skin
The most effective way to prevent skin cancer from developing is to limit exposure to sunlight.Sunscreen can help prevent damaging rays from penetrating our skin. Using the proper sun protection factor (SPF) for your skin type and circumstances may lower your risk of skin cancer; however sunscreens will not undo damage already done to skin. Other preventative measures may include:

Wear protective clothing, including a hat.
Wear sunglasses with 100 percent UV protection.
Use sunscreen every day.
Avoid being outside during peak sun hours (usually 10 a.m. to 3 p.m.)
Take precautions even on cloudy days.
Avoid tanning beds and sunlamps.

How Tanning Devices Work
For many years, various artificial sources of ultraviolet radiation have been widely used for tanning in the United States. People could buy single or double bulb devices at drug stores.

The most popular devices currently used in salons are clamshell-like tanning beds. The customer lies down on a Plexiglas surface and relaxes as lights from above and below reach the body. Most salon tanning devices have timers that automatically turn off after the recommended exposure time is up.

Older devices generally used light sources emitting short-wave ultraviolet rays (UVB), often advertised as tanning rays, which actually caused burning. Aware of the harmful effects of UVB radiation, including the increased risk of skin cancer, salon owners began using tanning beds that emit mostly long-wave (over 320 nanometers), UVA light sources, which some claimed to be safe.

Many tanners not only accept, but also expect, their skin to pass through these damaging phases. They believe that these damaging skin changes are the path to a deep, golden glow. They want to appear healthy, so they often accept pink, red, and even severe burns and blisters as necessary tribulations that must occur. The skin also sheds and regenerates new cells, but damage still occurs because UVA rays penetrate beyond the outer epidermis.

Are Artificial Tans Safer than Those From the Sun?
The myth about tanning beds is that UVA rays -- those used in tanning beds -- are less harmful than UVB rays because UVB can burn the outer layer of the skin more severely. The fact is that the UVA rays emitted from the Ultraviolet A light sources in tanning salons are two to three times more powerful than the UVA rays from the sun.

Many people believe that a good base tan gradually achieved will protect them from sunburn. Research says a tan is equivalent to applying a sunscreen with an SPF of two to four.

Scientists agree that ultraviolet radiation is damaging to our skin. The first effects of damage are visible pinkness and redness, or even blistering from a severe burn. Forms of photosensitivity including drug reactions and sun poisoning may also be initiated by tanning salon exposure.

The Consumer Product Safety Commission estimates that there were more than 1,800 hospital emergency clinic visits last year from visits from treatment of injuries sustained as a result of time spent at tanning salons. Most of these accidents were to the eyes -- particularly to the cornea. These accidents occur even though tanning salons are required to have goggles and place warnings on every bed that instructs the user to "WEAR PROTECTIVE EYEWEAR: FAILURE TO DO SO MAY RESULT IN SEVERE BURNS OR LONG-TERM INJURY TO THE EYES."

According to the Federal Trade Commission (FTC), consumers can also be harmed if printed advertising for home tanning units or salon operators lead customers to believe they can obtain a tan without harmful effects of the sun. Ad blurbs like, "Tan indoors with absolutely no harmful side effects," have become an interesting part of our landscape.

The Environment
The sun still lies some 93 million miles away, but the level of UV light today is higher than it was 50 or 100 years ago. This is due to a reduction of ozone in the earth's atmosphere. The ozone hole, which is now roughly the size of Europe, was discovered over Antarctica in 1985. Ozone serves as a filter to screen out and reduce the amount of UV light that we are exposed to. According to the Skin Cancer Foundation, for each one percent drop in ozone, there is a 3 to 6 percent increase in skin cancers. With less atmospheric ozone, a higher level of UV light reaches the earth's surface. Cloud cover and pollution do reduce UV, and climates with regular cloud cover have been shown to have 50 percent lower levels of UV light.

The UV index provides a forecast of likely UV exposure at noon. This forecast can help you determine what level SPF sunscreen will best protect your skin. The forecast is based on a scale of 1 (low) to 15 (high). Many Arkansas television stations carry the daily UV index during the scorching summer months. You can also determine the UV level for your area with a measuring device such as the ultra sensometer. The sensometer is an inexpensive, credit card sized device that measures UV light. As with the UV forecast, you may then determine the proper SPF sunscreen. The sensometer can also be used to test the effectiveness of your sunscreen and when it is time to apply more sunscreen.

Accessories That Make Tanning Worse
Special deals on tanning accessories, like accelerating lotions, are also often offered in coupon books given to college students. Sales of tanning lotion and gel can mean big business for salons. The purpose of these products is to accelerate and lengthen a tan. These products work by making the skin more transparent so that UVA rays can penetrate more deeply into the body. This creates a darker tan that will last longer because the rays have penetrated farther into the skin.

The Long-Term Effects of UV Exposure
According to Scott Marotti, a surgeon at Baptist Health Center in Little Rock, ultraviolet light actually thins the skin, making it less able to heal. Over a period of time, the effects of too much UVA exposure can lead to eye damage, immune system changes, cataracts, wrinkles and skin cancers.

Skin cancer is the most common form of cancer and approximately 90 percent of all skin cancers can be traced to UV exposure. The UVA rays penetrate so deeply that they can weaken the skin's inner connective tissue, cause collagen loss and decrease the number of blood vessels.

The Positive Effects of Tanning and Sunlight
A suntan is sometimes associated with good health and vitality. A tan is even able to create the illusion of a skinnier body.

The impact of vitamin D from the sun has become a major point over which both sides have brooded. But, recent research states just a small amount of sunlight is needed for the body to manufacture vitamin D. It doesn't take much sunlight to make all the vitamin D you can use, certainly far less than it takes to get tan.

Sunlight has also been prescribed as a cure for Seasonal Affective Disorder (SAD) during the dark cold winter months. According to the book Safe in the Sun, SAD is a disturbance of mood and behavior that occurs when the body clock gets confused by waking up in the dark. People who suffer from this condition experience a depression in the winter, usually starting in the early fall and continuing to worsen as the winter progresses. The depressed feelings begin to decrease when the days get longer and warmer in the spring. Symptoms include sadness, anxiety, irritability, decreased physical activity, increased appetite, carbohydrate craving, weight gain, extreme tiredness, need for more sleep, decreased sexual energies and difficulties trying to work. SAD is more likely to occur in women and often begins in a person's twenties or thirties.

"I have customers that say just laying on a bed once will lift their spirits and make them feel better," said Beck, of Premiere Tans. For sufferers of SAD, a treatment called phototherapy that makes use of wave frequencies present in sunlight is very successful. The treatment involves regular exposure to full-spectrum bright artificial light of a higher intensity than is usually present in either the home or the workplace.

Phototherapy has not yet achieved much popularity in Arkansas. Many doctors send patients to regular tanning beds instead. Some users also believe that tanning beds cure acne, arthritis, and sinus problems.

"I have customers that come in to treat everything from acne to cirrhosis," said Copher, of Ann's Tann'In.

Self-Tanners-The Safe Alternative
Bronzers and self-tanners have been around for many years, and up until recently have received a bad reputation for turning users skin a fake orange color. New products on the market are much more effective. They look natural, are easy to apply and work on men and women's skin. These products contain dihydroxyacetone, an ingredient that safely oxidizes on the skin's surface upon reacting with the protein in the upper layers of epidermis. This is a simple dyeing effect and as skin cells renew themselves, the tan fades. But, an artificial tan does not give you any more protection from the sun than you would have without it.

New Advances in Tanning
A new wave in tanning is beginning to hit Arkansas salons, but this wave is a whole lot safer. New self-tanning machines have become a new craze nationwide. These machines spray the body with self-tanner evenly out of small nozzles. So instead of taking a risk with a self-applied product, you can have a machine apply the color for you. This definitely is a step in the right direction for many salon owners who are seeing the future of the tanning business.

The Opinion of Medical Professionals
The American Medical Association (AMA) and the American Academy of Dermatology (AAD) have warned people for many years about the danger of tanning. In fact, AMA and AAD have urged action that would ban the sale and use of tanning equipment for non-medical purposes. The American Cancer Society, the AAD and the Skin Cancer Foundation all urge regular self-examinations of your skin. This will help to detect the beginnings of any new moles.

The average person tends to perceive skin cancer as a minor problem. "It's only skin cancer," is a common reaction. It's true that most skin cancers are curable, but they can still be serious and sometimes disfiguring. The American Cancer Society estimates that 50 percent of all people who live to the age 65 will have at least one. Hopefully a new sun-smarter generation of children can change this scary statistic for the future.