The gray September sky covering East Baltimore during pediatric resident Abha Gupta’s Grand Rounds presentation didn’t distract her from the topic – childhood skin cancer. After all, it was childhood cancer awareness month. Also, she knew that the increasing incidence of skin cancer in teens could be attributed to tanning indoors as well as outdoors under the sun.

“Artificial tanning is a big culprit in this,” said Gupta, citing studies showing an increasing incidence of both melanoma and non-melanoma skin cancers corresponding to an increasing use of indoor tanning, especially among adolescent females. Of the more than 1 million Americans who visit indoor tanning salons daily, according to the American Academy of Dermatology, 70 percent are females between the ages of 16 and 49. Also, more than 25 percent of teen girls use tanning salons three times or more in their lives.

Many are lured by the perception that tan skin is appealing, Gupta explained, and others by the overall mood improvement that tanning produces through elevating endorphin levels. But artificial ultraviolet radiation (UVR) also emits radiation 10 to 15 times higher than that of the sun, and frequent indoor tanners may receive up to 4.7 times the annual dose of UVR received by the sun. Also, children and adolescents are more susceptible to UV radiation than adults, added Gupta, noting research that suggests 50 percent of one’s lifetime UVR dose is received by age 20.

All this helps to explain why the National Institutes of Health in 2000 stated that “exposures to sunlamps or sun beds is known to be a human carcinogen,” and why The World Health Organization, the American Medical Association and the American Academy of Dermatology all support legislation to ban the use of artificial tanning devices by people younger than 18 years.

Nonetheless, Gupta said, public awareness of the risk still needs to be raised today as compliance with UVR protection is inconsistent, and melanoma rates continue to rise. Between 1973 and 2001, melanoma incidence in those under age 20 rose 2.9 percent, and now account for up to 3 percent of all pediatric cancers (Journal of Clinical Oncology 2005;23:4735-41). Ninety percent of pediatric melanoma cases, Gupta noted, occur in girls aged 10-19.

Are pediatricians aware of the problem? While 90 percent of pediatricians agree that preventing childhood sun exposure is important, only about half of pediatricians surveyed report discussing sun protection with their patients. Barriers to counseling include lack of time, reluctance to comply, patient disinterest, and lack of educational materials (Pediatrics 2004, Oct;114(4):1056-64).

Another problem is the delay of diagnosis in 40 percent of childhood melanoma cases, partly because pediatric melanomas tend to have atypical presentations of pink and white colorations with regular borders rather than the typically dark tones and irregular borders seen in adult melanomas (Pediatrics 2005, Mar;115(3):802-3).

What can pediatricians do? Identify higher risk patients, such as those with light skin and eyes, and a family history of skin cancer, and counsel them to avoid artificial UVR, use sun screen and minimize sun exposure. Gupta also recommends that pediatricians encourage their young patients to engage in endorphin-producing activities other than tanning, such as exercise.

Gupta concluded, “Artificial UVR exposure accumulates from childhood, the incidence of skin cancer is rapidly increasing, and pediatricians can play a vital role in prevention.”

For more information, see the American Academy of Pediatrics policy statement on ultraviolet radiation (Pediatrics, March 1, 2011).