JRSM >
Volume 94, Number 12 >
Pp. 636-637
Department of Dermatology, Amersham Hospital, Bucks, UK.
1
St John's Institute of Dermatology, St Thomas' Hospital, London SE1 7EH,
UK.
2
Department of Dermatology, Chelsea and Westminster Hospital, London SW10
9NH
Correspondence to: Dr M A B Roest, Department of Dermatology, Amersham Hospital, Bucks HP7 0JD, UK E-mail: mroest{at}doctors.org.uk
Sunbeds are widely used for cosmetic purposes though disapproved of by dermatologists. A survey from Central Scotland1 revealed that most users were female and under 35 years of age; 17% had more than 100 sunbed sessions a year.
CASE HISTORY
A woman of 34 was referred to the dermatology department while under psychiatric treatment for bulimia nervosa and alcohol detoxification. She had used sunbeds for up to half an hour three to four times a week over a ten-year period, at cosmetic tanning outlets. During sunny weeks in the UK she would also sunbathe for up to an hour using a protective lotion (SPF 6-8) and she had yearly two-week holidays to the Mediterranean. As a child she had burned easily but had never blistered. Two years before presentation her skin became dry and itchy and multiple rough lesions began to develop, but she continued to use sunbeds at the same frequency despite noticing two large lesions on her right shin and left breast. There was no family history of skin cancer.
On examination she had a very fair skin with green eyes and auburn hair. Actinic damage was evident on all sunbed exposed skin, comprising multiple irregular lentigines, telangiectasia and dryness (see Figure 1). The face also showed premature ageing with forehead, periorbital and perioral furrows and elastosis of the neck. Multiple actinic keratoses were distributed over the whole skin surface except for the axillae and the upper inner thighs. There was a 4 cm2 exophytic fungating mass on the anterior right mid-shin and a 2 cm2 fleshy lesion on the upper medial quadrant of the left breast. The lesions were excised and proved on histological examination to be moderately differentiated squamous cell carcinomas (SCCs); three further lesions removed were proliferative bowenoid actinic keratoses.
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Xeroderma pigmentosum (XP) and XP variant were excluded when ultraviolet
(UV)-irradiated fibroblast cultures from apparently normal skin showed normal
DNA repair and normal post-replication repair, respectively. On solar
simulator and monochromatic light tests, sensitivity to UV radiation was
normal. Since initial presentation, the patient has had multiple SCCs excised
and left inguinal node metastasis has been diagnosed. Surgical intervention
was complicated by wound dehiscence and infection. She is currently undergoing
combination therapy with isotretinoin, interferon 
-2a and calcitriol in
the hope of delaying disease progression.
COMMENT
This patient's heavy use of sunbeds seems to have been a form of dependency behaviour. Although XP and XP-variant have been excluded it is possible that she has an as yet unidentified genetic predisposition to photocarcinogenesis; furthermore, alcohol-induced immunosuppression may have promoted the development of squamous cell carcinoma.
Most fluorescent-tube sunbeds emit 95% or more UVA with only a small proportion of UVB. The long-term effects of sunbed use in human beings are uncertain because of the delay in development of chronic skin changes, but in hairless mice both UVA and UVB have been shown to induce squamous cell carcinomas2. Epidemiological studies suggest an increased risk of malignant melanoma associated with sunbed use, although the evidence is not strong3. Non-melanoma skin cancer following excess sunbed use has been described in a fair-skinned individual with very little exposure to sunlight4.
The British Photodermatology Group (BPG) have strongly discouraged the use of sunbeds for cosmetic tanning and recommend that those who persist in using such devices should limit themselves to two courses a year, each of no more than 10 sessions5. At present, commercial sunbed exposure is poorly controlled and customers receive inadequate advice and information6. Also the use of publicly available sunbeds remains unregulated in the UK.
Acknowledgments
We thank Professor C Arlett, MRC Research Unit, Brighton General Hospital, for performing fibroblast culture studies.
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  D. Lazovich, J. Forster, G. Sorensen, K. Emmons, J. Stryker, M.-F. Demierre, A. Hickle, and N. Remba Characteristics Associated With Use or Intention to Use Indoor Tanning Among Adolescents Arch Pediatr Adolesc Med, September 1, 2004; 158(9): 918 - 924. [Abstract] [Full Text] [PDF]
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