People who elect to undergo sunless tanning tend to continue behaviors that could increase their risk of skin cancer, according to a study published in JAMA Dermatology.

With the incidence of melanoma and nonmelanoma skin cancers on the rise in the United States, a recommended intervention to reduce preventable risk factors, such as UV tanning, is needed. Sunless tanning is considered to be a safe alternative, but how it affects other skin cancer risk behaviors among those who use the practice is unknown.

For this cross-sectional study, researchers accessed data from the National Health Interview Survey to review the outcomes and behaviors of 27,353 participants. The survey assessed patient demographics and risk-affecting behavior, such as indoor tanning, skin cancer screening, sunburn, and sun protective behaviors.

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Overall, 6.4% of survey participants reported using sunless tanning in the past year; 4.5% used sunless or fake tanning products, 0.8% used spray-on mist tans, and 1.1% used both. Factors associated with sunless tanning were college educated, non-Hispanic white, female, living in the Western United States, reporting higher sun sensitivity, and having a family history of skin cancer.

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Study results showed that although sunless tanners were more likely to have had a full-body skin examination and use sunscreen, they were also more likely to have a recent sunburn and have indoor tanned. They were also less likely to seek shade or to wear long pants or sleeves when outdoors.

Among indoor tanners, sunless tanners had a higher frequency of indoor tanning compared with those who did not sunless tan in the past 12 months; no other differences in risky skin cancer behaviors were reported.

Sunless tanning was not associated with a decrease in risky behavior among indoor tanners. The authors concluded that these “findings highlight the need for high-quality, longitudinal studies to better assess whether sunless tanning changes behaviors to better determine whether sunless tanning represents an effective public health strategy to reduce increasing skin cancer rates in the United States.”


Dodds M, Arron ST, Linos E, et al. Characteristics and skin cancer risk behaviors of adult sunless tanners in the United States[published online July 25, 2018]. JAMA Dermatol. doi: 10.1001/jamadermatol.2018.2054