It’s not like 25-year-old Jill Abbott dodged a bullet. She has a jagged three-inch scar on her right arm that shows she took a direct hit and needed surgery to remove a melanoma.
Still, she counts herself grateful to have only one scar.
“I have fair skin. I know I burn easily,” the Greenville redhead said. “Yet, due to peer pressure I laid out when I was younger without sunscreen and I went to tanning salons. Everyone did.”
In July 2010, a biopsy on a spot just below her shoulder she’d been watching change and grow for years was diagnosed as a melanoma.
“I didn’t really think it would happen to someone like me,” she said. “I never even knew anyone who’d had melanoma. And definitely not someone my age.”
Yet, national statistics show young women like Abbott in the 15 to 29 age group are seeing a big increase in melanomas, said Dr. Marshall Shuler of Carolina Dermatology Associates.
“We call that the ‘prom effect,’” he said. “Even one exposure increases the risk of developing melanoma.”
Melanoma is the most prevalent cancer in the 20 to 29 age group and the top cancer killer in women ages 25 to 29, according to the National Melanoma Awareness Project.
Statistics like those have prompted new bans on indoor tanning for youths under 18 in five states within the past two years. Texas joined California, Vermont, Oregon and Nevada on June 17 as the latest state to impose such a ban on minors younger than 18.
South Carolina is one of 33 states, along with Washington, D.C., with at least some limits on the use of indoor tanning facilities for young people. Current state law requires that anyone under 18 “have written permission from a parent or guardian signed in the presence of the tanning facility operator.”
John Overstreet, executive director of the Indoor Tanning Association, said South Carolina’s law is a move in the right direction. “The industry’s best practice is parental consent.”
He said the association of tanning facility owners holds that indoor tanning remains safe, and because it’s supervised and takes place in a controlled environment, it’s safer for teens than spending time on the beach.
Still, 31 states overall introduced legislation to limit or ban indoor tanning for youth in the most recent legislative session.
“The number of states to have active legislation is at a record level,” said Dr. Bruce Brod, a Lancaster, Pa.-based dermatologist who is the chairman of the American Academy of Dermatology’s Legislative Affairs Committee. “A number of states that had never considered it are doing so now.”
In addition to the five states that banned use for those under 18, both New York and New Jersey recently banned tanning-booth use for those under 17. Brod said Illinois is considering a law to ban use for those under 18, and, he said, “Your neighbor, North Carolina, is getting serious about it.”
With laws like South Carolina’s parental consent requirement, “Enforcement is the chief issue with things like that,” Shuler said. “The AAD is trying to get better control for states on that.”
Brod said federal regulators are addressing the issue, too.
In May, the U.S. Food and Drug Administration announced it was reviewing ultraviolet tanning devices. It proposed they be considered as Class II medical devices, meaning they would then be designated as “moderate risk devices.”
The FDA cited statistics from the American Academy of Dermatology that showed that the risk of melanoma, “the deadliest type of skin cancer,” increases 75 percent for those who have been exposed to just one round of indoor tanning ultraviolet radiation. The risk increases with each use.
If the change to a Class II device occurs, it would require warning labels on the devices, in promotional brochures and on websites to alert people to the dangers associated with use.
Currently, Brod said, tanning beds are a Class I medical device.
“That puts them in the same class as a tongue depressor or a bandage,” he said. “I think we’re seeing a little domino effect. The evidence is clear there is more of a public groundswell now.”
The FDA isn’t the only federal group looking at indoor tanning. Last month, a group of bi-partisan members of Congress announced the formation of the Congressional Skin Cancer Caucus to “focus on addressing a growing epidemic of skin cancer among Americans,” according to a statement from the American Academy of Dermatology.
The goal of the caucus, its members said, is to support legislation and public policies aimed at raising awareness, promoting screening and early detection and improving access to treatment.
Another step into the issue at the federal level came in early June when a 10 percent tax on indoor tanning became permanent. The tax had been temporarily levied since July 2010 as a way to help pay for the Affordable Health Care Act. It is expected to raise $2.7 billion in revenue every decade.
The so-called “tan tax” has been a blow to indoor tanning businesses, said the ITA’s Overstreet. Since 2009 when the recession began, 16 percent of South Carolina’s tanning facilities have closed, he said.
“These businesses are really, really struggling right now,” he said. “Money for tanning is disposable income. And it’s mainly young people, who have the least amount of that type of income.”
Overstreet said momentum to create tanning bans only comes when “one side is pushing really, really hard. You have a very powerful group talking to people who don’t know much about the subject.
“If someone comes in, in a white coat, they’ll listen to them.”
Everyone wants to help children, Overstreet said, and avoiding sunburn should be the top thing to consider for everyone — at every age — whether it’s at the beach or indoors.
“Informed consent is important,” he said. “That means those taking certain drugs that react to the sun should not tan. Those who are pregnant, those with fair skin and those with a history of skin cancer in their family.
“The bottom line is, if a teenager wants to get a suntan, and they’re not allowed to do it indoors in a controlled environment, they go outdoors and get burned. There are no time limits outdoors. In their zeal to prevent indoor tanning, they’re actually making things more hazardous.”
Brod said the renewed emphasis to ban indoor tanning for youngsters comes from increasingly dire data showing higher rates of melanoma and deaths.
“It’s long overdue,” Brod said. “Since they became popular in the 1980s, they’ve led to deaths. The rate for young women getting melanomas, especially, has doubled since then.”
A generation ago, the typical patient with a melanoma was usually a male in his 50s or older. A typical patient was someone who worked outdoors for a living.
“It was unusual to see a young woman with melanoma,” he said, “but not now.”
The role of the academy, Shuler said, is to try to educate and prevent disorders.
“The ideal situation is we’d like to have it eliminated,” he said. “There is no safe tan.”
Whether a tan is fashionable has trended upward and downward over the last century. Shuler said the idea of actually working to be tanned didn’t come about until the 1930s when Coco Chanel sported a tan and popularized it as a badge of honor for the leisure class.
“Before that, those with a tan were agrarian and were looked down upon for having to work outdoors,” he said. “But then this shift came about and, if you had a tan, it was a sign of affluence.”
These days the pendulum is shifting back. A popular blog, Pretty in Pale, raises awareness about melanoma and helps young women love the skin they were born with. A similar effort, palegirlspeaks.com, is from a mom who was diagnosed with melanoma at age 25 and wrote a book about it.
A website, PaleIsTheNewTan.com, takes a different route and ridicules those who clearly spend too much time tanning indoors. Other national efforts tout “pale is beautiful” to counteract the tanning ideal.
Abbott said her own 15-month-old daughter, Callie, will never go outside without sunblock. While slathering her daughter with sunscreen — “I lotion her every day” — before for a splash in the fountain at downtown’s Riverwalk, Abbott said she’s altered her personal thinking, too.
“I’m embracing the whiteness now,” she said. “I’m really trying to let young girls know they have alternatives like a spray-on tan or a bronzer.
“Embrace the skin God gave you,” she said. “It’s just not worth it.”