The association of use of sunbeds with cutaneous malignant melanoma and other skin cancers: A systematic review


  • The International Agency for Research on Cancer Working Group on artificial ultraviolet (UV) light and skin cancer

    Corresponding author
    • International Agency for Research on Cancer, 150 Cours Albert Thomas, F-69372 Lyon Cedex 08, France
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    • Members of the Working Group: Adele Green (Chair), Queensland Institute of Medical Research, PO Royal Brisbane Hospital, Brisbane, Qld, Australia; Philippe Autier, Unit of Epidemiology, Prevention and Screening, Jules Bordet Institute, Brussels, Belgium (current address is: International Agency for Research on Cancer, Lyon, France); Mathieu Boniol and Peter Boyle, International Agency for Research on Cancer, Lyon, France; Jean-Francois Doré, INSERM U590, Centre Léon Bérard, Lyon, France; Sara Gandini, Division of Biostatistics and Epidemiology, European Institute of Oncology, Milan, Italy; Julia Newton-Bishop, Cancer Research UK Genetic Epidemiology Division, St James's University Hospital, Leeds, UK; Béatrice Secretan,* International Agency for Research on Cancer, Lyon, France; Stephen J Walter, Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont., Canada; Martin A. Weinstock, Dermatoepidemiology Unit, VA Medical Center, Providence, and Departments of Dermatology and Community Health, Brown University, Providence, Rhode Island; and Johan Westerdahl, Department of Surgery, Lund University Hospital, Lund, Sweden.

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Exposure to solar ultraviolet (UV) radiation is a known cause of skin cancer. Sunbed use represents an increasingly frequent source of artificial UV exposure in light-skinned populations. To assess the available evidence of the association between sunbed use and cutaneous malignant melanoma (melanoma) and other skin cancers, a systematic review of the literature till March 2006 on epidemiological and biological studies on sunbed use was performed in Pubmed, ISI Web of Science, Embase, Pascal, Cochrane library, Lilacs and Medcarib. Search for keywords in the title and in the abstract was done systematically and supplemented by manual searches. Only case–control, cohort or cross-sectional studies were selected. Data were abstracted by means of a standardized data-collection protocol. Based on 19 informative studies, ever-use of sunbeds was positively associated with melanoma (summary relative risk, 1.15; 95% CI, 1.00–1.31), although there was no consistent evidence of a dose–response relationship. First exposure to sunbeds before 35 years of age significantly increased the risk of melanoma, based on 7 informative studies (summary relative risk, 1.75; 95% CI, 1.35–2.26). The summary relative risk of 3 studies of squamous cell carcinoma showed an increased risk. For basal cell carcinoma, the studies did not support an association. The evidence does not support a protective effect of the use of sunbeds against damage to the skin from subsequent sun exposure. Young adults should be discouraged from using indoor tanning equipment and restricted access to sunbeds by minors should be strongly considered. © 2006 Wiley-Liss, Inc.