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Burgard and Reichrath, and Reichrath et al.There have been two separate reviews published by the same study group which have examined the literature on solarium use and the risk of melanoma. These reviews were conducted as a supplement to a meta-analysis of the same body of evidence published by Burgard et al in 2018. ARPANSA had previously reviewed this meta-analysis and provided comment. Briefly, in the 2018 meta-analysis, the authors included 2 cohort and 29 case-control studies and reported overall risk factors supporting an association between varying degrees of solarium exposure ranging from moderate to heavy use and a risk of malignant melanoma. Further, the risk of melanoma increased with higher use of solariums suggesting a dose-response relationship with ultraviolet radiation (UVR) exposure. Despite these results, the authors pointed to weaknesses in the included studies being a major cause of bias and thus concluded that there was no substantiated evidence of moderate solarium use being a causal factor for the development of malignant melanoma.
The current 2020 reviews provide further critique regarding the quality of the studies that form the basis of solarium use as a risk factor for melanoma. Specifically, they focus on “moderate” sunbed use being used as the criteria to question the scientific basis of current mainstream advice that the use of solaria is carcinogenic from exposure to artificial UVR, which is classified as a Group 1 carcinogen by the International Agency for Research on Cancer. The reviews discuss the impact of confounders including solar UVR exposure, age of exposure and smoking status and argue that the risk of bias presented by these factors would most likely lead to an overestimation of the risk. In relation to the criteria of “moderate” sunbed use, the authors argue that there is no strong evidence for melanoma development at UVR exposures below levels sufficient to cause erythema (sunburn).
Solarium Use and Risk for Malignant Melanoma: Many Open Questions, Not the Time to Close the Debate
Sunbeds and Melanoma Risk: Many Open Questions, Not Yet Time to Close the Debate
Despite the critiques of the studies reporting an increased risk between solarium use and melanoma provided within the reviews, the included studies revealed a consistent relationship despite some of their weaknesses.
The authors’ assertions about the safety of moderate solarium use present the question about how ‘moderate’ is defined and, further, how use can be monitored and enforced. Before the total ban of commercial solaria in Australia by 2016, the solarium industry was guided by a voluntary code of practice which focussed on limiting use of sunbeds by factors such as age and skin type of the client. A 2011 study by Makin et al. demonstrated poor adherence by solarium operators to the requirements of this code when accepting clients.
Despite the conclusions of these reviews, the positive associations consistently demonstrating an increased risk between solarium use and melanoma in epidemiological studies continue to support Australia’s nation-wide policy to ban all commercial solaria as a strong health protection measure.
