Dying to be Tan

At 14, fair-skinned, blue-eyed Charlie Guild got a bad sunburn after she forgot to reapply her sunscreen at a pool party. When she was 16, she mistakenly fried herself on a family Christmas vacation trip to Puerto Vallarta. Charlie was just 25 when she learned she had melanoma. She died from it eight months later. "I never had the faintest idea that literally a burn could cause you to get a fatal disease. It can," says her mom, Valerie Guild, president of the Charlie Guild Melanoma Foundation (charlie.org), a national advocacy group trying to raise awareness about skin cancer prevention and detection through sun-safety education for children and other efforts.

Getting tan may not be as harmful as smoking. But unprotected exposure to its ultraviolet rays in the teen years dramatically increases the risk of skin cancer, the most common form of the disease in America today. And doctors are concerned about the rising rates of skin cancer, particularly sunburn-linked malignant melanoma--now the top cancer killer of women aged 25 to 30. One in 70 Americans will get melanoma in his or her lifetime now, according to the American Cancer Society. That's up dramatically from the 1930s and 40s, when pale skin and conservative clothing were in vogue, and Americans had a one-in-1,500 chance of getting the disease.

Last year doctors diagnosed more than 59,000 new cases of malignant melanoma and about one million new cases of basal or squamous cell carcinoma, believed to be the result of cumulative sun exposure. "The stage for this stuff is set when you're 18, when you're in the tanning bed, thinking this makes you look cool," says Dr. Mark Jewell, president of the American Society for Aesthetic Plastic Surgery.

But it's been tough to get that message to image-conscious teenagers. Despite warnings, they continue to bake in the sun--and in tanning booths. A June 2002 study in the journal Pediatrics found that more than one third of 17-year-old girls use tanning salons. Among 14-year-olds, that number was 7 percent. When teens, aged 12 to 17, were asked during a recent survey by the American Academy of Dermatology if they were aware that getting a suntan can be dangerous for their skin, an overwhelming majority (79 percent) said "yes." And 81 percent said that they know that childhood sunburns increase their risk of developing skin cancer as an adult. Still, 60 percent of the teens surveyed admitted that they had suffered at least one sunburn during the summer of 2004 and 47 percent said they think people look healthier with a tan. And 66 percent believed that people appear physically better with a tan.

"Our simple prevention message has largely fallen on deaf ears," says Dr. James Spencer, educational spokesman for the Skin Cancer Foundation and director of the division of dermatologic surgery at Mount Sinai Medical Center in New York.

Some state legislatures have stepped in to help curb one popular form of teen tanning--indoor beds. Twenty-two states now limit teen access, requiring parental consent or banning the use of tanning beds altogether by those under 14. As of January 1, 2005, for example, a new California state law prohibits kids under 14 from using a tanning salon and requires parental consent for 14- to 17-year-olds. North Carolina and New Hampshire also prohibit kids under 14 from using booths. Health professionals like Spencer would like to see even tighter restrictions.

"We do not sell tobacco and alcohol to teenagers, not even with parental permission," he says. Tanning booths, he adds, should fall into the same category.

Monitoring teens' behavior outdoors is much harder. It's too simplistic to merely warn kids to just say no to sun. In fact, teens--and adults--need some sun to get vitamin D, which helps build strong bones and protect against lymphoma and prostate, lung and colon cancer, rheumatoid arthritis, multiple sclerosis and type I diabetes, says Dr. Michael Holick, author of "The UV Advantage" and professor of medicine, physiology and biophysics at Boston University. "Sensible sun exposure is really important for teenagers. That's their formative years for when they accrue the most bone," he explains.

The salon industry has jumped on that argument, touting moderate indoor tanning as a healthy activity. "Some sun is not only good for you, it's essential for good health," says John Overstreet, executive director of the Indoor Tanning Association, which represents salon operators. "We're not allowed to make health claims. But the evidence is pretty clear that ultraviolet [light] has health benefits."

Health officials have tried to counter such claims. Spencer points out that teens can also boost their Vitamin D levels by taking a vitamin and drinking more milk. And the World Health Organization, the U.S. Centers for Disease Control and the American Academy of Dermatology advise teens to avoid tanning salons completely. Even Holick warns teens not to overdo their sun exposure; just a quick walk to the store can provide Vitamin D benefits.

No one's recommending teens avoid the sun altogether--just that they take precautions. Thick sunscreen absorbs or reflects UV light, so you're not getting the penetrating rays that are damaging the skin. Doctors recommend using sunscreen with both ultraviolet A and B protection and an SPF of 15 or higher, and re-applying it every two hours. While it's possible to get a tan through sunscreen--albeit at a slower rate--the lotion helps to prevent burning and decreases the risk of developing skin cancer later in life. Not wearing sunscreen, "is like not wearing a bicycle helmet," says Dr. Daniel Krowchuk, professor of pediatrics and dermatology at Wake Forest University School of Medicine and chair of the American Academy of Pediatrics' section on dermatology.

But while one bike accident may be enough to convince a teen to wear a helmet, a sunburn doesn't always have the same effect. Only about 35 percent of teens use sunscreen, according to a June 2002 report in Pediatrics.

A safer option: self-tanning lotions. The products contain dihydroxyacetone (DHA), which interacts with the dead cells on the skin's surface and darkens them. "Within a few hours, you start to see a color change, and it tends to fade over a week or so," says Krowchuk. He recommends that teens read the labels and buy a self-tanner that's non-acnegenic or non-comedogenic so it doesn't block pores and cause blackheads and whiteheads.

The best option, of course, is "taking a leap of faith and saying, 'I don't need to look so tan,'" says Krowchuk. But even he admits "that is not an easy thing to get people to buy into."

Ashley Charmichael, 20, who will be a junior this fall at the University of Northern Iowa, knows about the potential dangers but says she loves being tan. "I like the way that my skin looks. I feel healthier, although I know it's not healthier," says the former lifeguard, who used tanning booths and natural sunlight throughout her teens to achieve her glow. "Right now it's worth it for me to have the color and feel good about myself...It's winning over now, the instant gratification."

"[Teens tan] because they want to look sexy for the prom this weekend. You're telling them to worry about something when they're 45. That's a million miles away, and the prom is this weekend," says Spencer. "One thing that would help is if it wasn't sexy to be tan." Pale skin was in during the mid-20th century, but many young celebrities today look like they just stepped off the beach--even in the middle of winter. Teen icons like Paris Hilton and Lindsay Lohan have been blamed for perpetuating the rise in "tanorexia" (a term that's come to be associated with people who never think they're sufficiently bronzed).

That may change as the celebrities age. As Spencer points out, "By their mid- to late 30s, they're starting to look like leathery old women." (Compare that to beautiful, 30-something stars like Nicole Kidman whose smooth skin is often described as "luminescent" or "porcelain"). But until then, teens are more likely to listen to their iPods than warnings about wrinkles and skin cancer. Too bad. It may be true that you can never be too rich, but you can be too tan. Lindsay, are you listening?