Alert on skin cancer risks linked to sunbeds

Tiago R. Matos Myrto Trakatelli The incidence of skin cancer has been rising over the past decades, mainly due to ultraviolet (UV) exposure. One out of three human cancers, is skin cancer, making skin cancer the most common cancer worldwide.1 In the United States, more people are diagnosed with skin cancer each year than all other cancers combined,1 leading to an annual cost of treating skin cancers estimated at $8.1 billion.2 Individuals who tan indoors have an 83% higher risk of developing squamous cell carcinoma3 and a 29% higher risk of developing basal cell carcinoma.4 It results in more than 419,000 cases of skin cancer in the United States each year, including about 245,000 basal cell carcinomas, 168,000 squamous cell carcinomas, and 6200 melanomas.4 It leads to a direct medical cost attributable to indoor tanning of $343.1 million annually in the USA.5 The European Commission's 2021 Europe’s Beating Cancer Plan (EBCP), funded with €4 billion, aimed to improve cancer prevention, diagnosis, and treatment until 2025. As part of this, the Commission proposed reducing UV exposure from sunbeds, recognizing their link to skin cancer. In 2023, stakeholders, including the EADV, provided feedback advocating for stricter regulations. However, on 4 February 2025, the new Commission dropped the initiative, citing “lack of evidence to suggest that further measures would add to the protection of EU citizens from health risks associated with sunbeds”. Conversely, on 10 February 2025, the WHO Executive Board adopted a resolution to make Skin diseases as a global public health priority (EB156(24)). For example, the UK put into force specific legislation aimed at controlling the cosmetic use of sunbeds on 8 April 2011, named the Sunbeds (Regulation) Bill. Other general legislative provisions can also be applied to the use of sunbeds, such as the Health and Safety at Work Act (1974) and the Management of Health and Safety at Work Regulations (1999), generic pieces of health and safety legislation that require businesses and individuals to assess the health and safety risks created by their work activities, including the risks to employees and customers, and take measures to control those risks as far as is reasonably practicable. Following the recommendation of the 4th edition of the European Code Against Cancer it says ‘Avoid too much sun, especially for children. Use sun protection. Do not use sunbeds.’, at the end of 2023, the EC had an open call for additional recommendations on reducing the health risks associated with using sunbeds, receiving a total of 45 responses (Figure 1). Furthermore, a survey was conducted with the Cancer sub-group of the Public Health Expert Group of each European Union member state and European Free Trade Association countries, receiving replies from 21 countries. As more nations prepare recommendations, Matos et al.6 provide a summary of the findings shared during the webinar of the Cancer Stakeholder Group together with published scientific evidence. Despite the association between sunbeds and skin cancer, UV exposure also offers health benefits. Stevenson et al. observed that individuals with more active sun-seeking behaviors or those living in geographic areas with higher UV exposure had a lower risk of all-cause, cardiovascular disease (CVD), and cancer mortality.7 Additional studies noted a correlation between latitude and mortality, indicating that residing closer to the equator is linked to higher life expectancy, lower CVD mortality, and reduced mortality from several types of cancer.8-10 Low sun UV exposure in high latitudes is associated with low vitamin D levels, which is negatively correlated with health outcomes. Sun-driven UV and sunbed UV differ in composition and intensity; while sunlight provides a natural balance of UVA and UVB rays, sunbeds predominantly emit higher levels of UVA. Therefore, the challenge lies in determining how to obtain sufficient UV exposure safely with the optimal UVA-UVB ratio while avoiding the risks of overexposure. In conclusion, cautioning the use of sunbeds will be critical, particularly in the context of reducing skin cancer. Nineteen of the twenty-one countries, which reported to the EC, agreed to have EU-level initiatives regarding tanning devices. The EU's recommendations are a crucial preventive measure for safer practices and equipment standards, significantly contributing to public health efforts to reduce skin cancer incidence, and promoting overall well-being. This article is an initiative from the EADV's Advocacy Working Group, written by Dr. Tiago R. Matos with input from Sarah Walsh, Alexander J. Stratigos, and Myrto Trakatelli. The authors have written the EADV's recommendation to the EC call on Prevention of Cancer—reducing the health risks associated with using sunbeds, and were part of the webinar of the Cancer Stakeholder Group and participated at the EC's webinar of the Cancer Stakeholder Group. None to declare. None to declare. The manuscript does not contain information or images relating to patients. It adheres to the ICMJE Recommendations for patient privacy. Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.