In a report released today, the All Party Parliamentary Group on Skin (APPGS) outline their recommendations to the Department of Health on extending sunbed regulation.

The report comes at a time when rates of malignant melanoma, the most dangerous form of skin cancer, are five times higher in the UK than they were in the 1970s. According to Cancer Research UK, the dramatic rise can be attributed partly to the rise of package holidays, the fashion for a ‘healthy’ tan, and a boom in sunbed use.

Increased rates of melanoma

Cancer Research states that sunbed use raises the chance of developing a melanoma by nearly 59 per cent in first-time users under the age of 35. According to an article published in the International Journal of Cancer in 2012, among those who had ever used a sunbed and were diagnosed between 18-29 years of age, three quarters (76 per cent) of melanomas were attributable to sunbed use. The World Health Organisation lists sunbeds as a Group 1 carcinogen, the same classification given to tobacco.

The link between the use of sunbeds and skin cancer forms part of the APPGS enquiry. Gary Lipman, chairman of The Sunbed Association (which represents 20 per cent of the industry), refutes that sunbed use is linked with increased risk of malignant melanoma. However, the majority of the other members of the inquiry believe that there is a proven link:

‘Sunbeds have been shown to increase the risk of malignant melanoma (Boniol et al, 2012), basal cell carcinoma and squamous cell carcinoma (Wehner et al, 2012). Use in childhood and young adulthood particularly increases the risk of skin cancer (Boniol et al, 2012, Autier et al, 2008).’

While the cause for the rise in melanoma rates is attributed to varying sources of UV light, sunbeds are one of the most easily regulated factors in the equation.

Greater regulation

The APPGS’s core recommendations are for greater sunbed regulation in England. As advised by the British Association of Dermatologists, this would include compliance testing for radiant exposure, a ban on unstaffed tanning facilities, screening of customers’ skin, provision of balanced health information and provision of safety goggles.

While the recommendations would help to mitigate unnecessary skin cancer risk, without a licensing system, these new proposals could be difficult to enforce. At present, tanning salons are licensed in Wales, Scotland and London. Elsewhere, councils struggle to ensure operators are using safe equipment. They also face problems trying to enforce the age limit of 18, because children are able to access unmanned coin-operated booths. Unmanned sunbeds are banned in Scotland, Northern Ireland and Wales, but not in England.

A variety of tanning options exist throughout England – from proficient, high street businesses to coin-operated booths in the back of nail salons, spas and hairdressers. The lack of licensing means it is hard for local councils to clamp down on operators that break the current rules, so licensing powers would give local authorities more flexibility to deal with poor practice. A 2009 survey of local authorities suggested that the majority would welcome the introduction of mandatory licensing of sunbed outlets.

Case study: Liverpool City Council

Liverpool City Council have again raised this concern today, and called for licensing powers to try to cut down on the number of people being diagnosed with skin cancer. The city has some of the highest rates of skin cancer in the country, and sunbed use is much higher than the UK average. Since 2000, the council says the number of cases of skin cancer among women in Liverpool has risen by 129 per cent, more than double the UK average.

The reversal of the north-south latitude trend

Traditionally, melanoma incidence has shown a well-established increase from north to south in England and other northern countries. This is because solar UV levels are highly dependent on latitude of residence. Melanoma has also predominantly affected white, affluent populations.

However, a study published in the British Journal of Dermatology in June last year showed that between 1996 and 2006, there had been a reversal of north-south latitude trends among the young female population. Incidence of melanoma was particularly high among young people in northern regions, and particularly among moderately deprived female subjects. The advent of budget holidays and the increased accessibility of sunbeds were cited in the study as the most likely explanation for the reversal in the north-south latitude gradient.

In northern English cities, where levels of poverty are more acute, the belief that a tan signifies success and wealth has become widespread. The prevalence of ‘perma-tanned’ celebrity figures has contributed to this idea. But as cities like Liverpool have found, the popularity for tanned skin can come with a significant health risk.

The Department of Health would be wise to introduce APPGS’s recommendations. However, without the implementation of a new system of local authority licensing, the recommendations may prove hard to enforce.

Tags: All Party Parliamentary Group on Skin, APPGS, British Association of Dermatologists, British Journal Dermatology, Cancer Research UK, carcinogen, Gary Lipman, Liverpool City Council, melanoma, skin cancer, Sunbed Association, sunbeds, tobacco, WHO