Skin cancer is the most common type of cancer in the US, accounting for more than one million cases a year. In fact, up to 50% of Americans who live to age 65 will have skin cancer at least once.

Skin cancer is divided into two classes—nonmelanoma and melanoma . Nonmelanoma skin cancer is more common and, if diagnosed and treated early, has a 90% cure rate. Melanoma accounts for about 4% of all skin cancers, but it is the deadliest form. Approximately one person dies from melanoma every hour.

Sun exposure, specifically to the ultraviolet radiation, is the leading cause of skin cancer. Knowing this makes skin cancer a largely preventable disease. It stands to reason that educating people on how to minimize exposure to the sun’s harmful rays would lead to a decrease in skin cancer diagnoses. That is not the case—even with extensive education campaigns, the incidence of skin cancer has increased at a rate of almost 3% a year since 1981.

Why is it that most Americans who recognize that overexposure to the sun is unhealthy do very little to protect their skin from the sun? Choosing to do something even while knowing it has potentially harmful consequences is at the root of addiction, such as with a drug or alcohol addiction. Can tanning be considered a type of “addiction”? A study published in the August 2005 issue of Archives of Dermatology investigated whether people who tan may have a type of substance-related disorder involving tanning.

About the Study

The study included 145 beachgoers on Galveston Island in Texas. The researchers used two substance-related disorder assessment tools that are typically used to screen for alcohol abuse and dependence—the CAGE (Cut down, Annoyed, Guilty, Eye-opener) Questionnaire and the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for substance-related disorders.

The questions were slightly modified to reflect sun tanning as the “substance” in question. Examples of the modified CAGE questions include:

  • Do you try to cut down on the time you spend in the sun, but still find yourself suntanning?
  • Do you ever feel guilty that you are in the sun too much?

Examples of the modified DSM-IV questions include:

  • Do you think you need to spend more and more time in the sun to maintain your perfect tan?
  • Have you ever missed work, a social engagement, or school because of a sun burn?
  • Does [believing that you can get skin cancer from the sun and tanning beds] keep you from spending time in the sun or going to tanning beds?

The Findings

Using the modified CAGE (Cut down, Annoyed, Guilty, Eye-opener) Questionnaire, 38 (26%) of respondents were classified as ultraviolet light (UVL) dependent. With the modified DSM-IV criteria, 77 (53%) of the beachgoers interviewed were UVL dependent.

The study’s authors concluded that people who chronically expose themselves to UVL to tan may have some type of UVL substance-related disorder.

How Does This Affect You?

Thinking of chronic tanning as a type of addiction would help explain why, in the face of mounting evidence to its dangers, people continue to expose themselves to ultraviolet light through tanning. This is a novel, and possibly controversial, way of looking at tanning that has interesting implications for public health campaigns about tanning and skin cancer. If tanning is addictive, perhaps more regulations around indoor tanning are appropriate. Or, more targeted interventions for people at risk for UVL substance-related disorder may be effective.

This is, however, just one study with a small sample size and self-reported answers. Further study would be necessary before it can be considered more than an interesting theory. In the meantime, there are many things you can do to help reduce your risk of developing skin cancer, including:

  • Avoid being in the sun too long, particularly between the hours of 10 am and 4 pm when the suns ultraviolet rays are most intense.
  • Try to stay in the shade and remember that sunlight can reflect off water, sand, and snow, and can reach below the water’s surface.
  • Protect your skin with clothing, such as a long-sleeved shirt and a hat with a broad brim.
  • Use a sunscreen with an SPF factor of 15 or more on areas of skin exposed to the sun, including your lips.
  • Apply sunscreen thickly before you go outside on all exposed skin, and reapply it every 2 hours. Remember to use sunscreen even on cloudy days because the UV light still comes through the clouds.
  • Wear sunglasses that block UVA and UVB light.
  • Avoid other sources of UV light like tanning beds and sun lamps.