Over the past few decades, public awareness of skin cancer has grown dramatically, and so has our understanding of how to prevent it. What was once seen as a minor, easily treated condition is now recognised as a serious health concern, with rising incidence and profound consequences for individuals and healthcare systems alike.

In 2021, there were 6.6 million cases of skin cancer globally, with an age-standardised incidence rate of 8 per 100,000 people.¹ In the UK alone, more than 2,300 people die from melanoma skin cancer each year—that’s over six lives lost every day.² While malignant melanoma accounts for a smaller proportion of total skin cancer cases, it is far more likely to be deadly, and thus is responsible for the majority of skin cancer-related deaths worldwide.³

One in every three cancers diagnosed is a type of skin cancer, making it one of the most common—and yet most preventable—forms of cancer.⁴ And although tanning may still be culturally celebrated, it’s important to remember that a tan is a sign of skin damage, not health. When your skin darkens, it’s reacting to DNA damage caused by UV exposure. Those with lighter skin, especially individuals with higher levels of pheomelanin (responsible for red hair and freckles), are particularly vulnerable, as this pigment is more likely to produce harmful free radicals during ultraviolet (UV) exposure.^5,6

This article explores the rise of skin cancer awareness, the cultural and psychological drivers behind tanning behaviours, the impact of tanning beds, and why sunless tanning remains the only truly safe way to achieve a bronzed glow, alongside practical steps we can all take to protect our skin now and into the future.

Attitudes Towards Skin Cancer Prevention

Not so long ago, sun exposure was widely embraced—tanned skin symbolised leisure, vitality, and an enviable holiday abroad. A bronzed glow suggested you’d been somewhere warm and relaxing, a marker of affluence and escape. Ironically, in earlier centuries, it was paler skin that carried status, denoting a life free from outdoor labour. These shifting ideals highlight how beauty standards and cultural values have always influenced behaviours around sun exposure.

Over time, however, health awareness has begun to outpace aesthetic trends. Just as society moved from doctor-endorsed cigarette ads⁷ to widespread anti-smoking campaigns, perceptions around tanning have changed, too. Today, skin cancer prevention features far more prominently in public discourse, reflecting growing awareness of the risks and a broader shift in health-conscious behaviours.

The dangers of UV exposure—once downplayed or misunderstood—are now widely recognised. Skin ageing, pigmentation, and cancer risk have all been linked to sun damage, with modern skincare products frequently including UV protection as a standard feature. Advertising increasingly promotes prevention over correction, with sun safety messages woven into both health and beauty campaigns.

Yet, despite this progress, the allure of a tan persists. Tanned skin remains desirable for many, whether achieved through sunbathing, tanning beds, or the safer alternative of fake tan products.

The Persistence of Indoor Tanning—Despite the Risks

As awareness of UV damage has grown, many people have shifted to fake tanning products as a safer alternative. Yet indoor tanning remains surprisingly common, especially among young people and women. Between 1986 and 2012, ever-use of tanning beds was reported by 11% of Australians, 35% of Americans, and 42% of Europeans.⁸ More recently, 33% of adults and 10% of adolescents reported having used indoor tanning.⁹ Although use is declining, particularly among teens, a 2024 UK survey still found that 28% of adults, with usage rising to 43% among those aged 18–25, continue to use tanning beds.¹⁰

Why does this matter? Because the link between indoor tanning and skin cancer is well established. A 2021 meta-analysis found that ever using tanning beds increases the risk of cutaneous melanoma by 27%.¹¹ The risk rises sharply with frequent use; those who use sunbeds ten or more times per year face significantly higher odds of developing melanoma or multiple primary melanomas.^11-13 Similar associations exist for non-melanoma skin cancers, such as squamous cell carcinoma and basal cell carcinoma.^11,14,15 Starting young, especially in high school or college, further amplifies the danger.^15,16 The number of keratinocyte carcinoma (non-melanoma skin cancer) cases linked to sunbed use is now comparable to the burden of lung cancer caused by smoking.⁸

So why do people still tan? Cultural beauty ideals play a powerful role. For many, a tan still signals health, attractiveness, or confidence.^17,18 Others may underestimate the risks or believe in persistent myths—like the idea that a “base tan” offers protection, or that tanning beds are good for acne or vitamin D.^19,20 There’s also a false sense of control: the damage feels distant and fixable, and skin cancer doesn’t always evoke the same fear as other cancers.²¹ But the science is clear—there is no safe way to tan using UV, and the consequences can be lasting.

How is it so Harmful?

Whether from the sun or a tanning bed, the pursuit of a tan comes at a significant biological cost. Both sources emit ultraviolet radiation (UVR)—specifically UVA (320–400 nm) and a smaller fraction of UVB (280–320 nm)—and both can initiate processes that directly contribute to skin carcinogenesis.^22,23

DNA Damage: The Root of the Problem

UV radiation induces DNA damage, which can trigger mutations that initiate and drive cancer development. UVB, in particular, is absorbed strongly by aromatic heterocyclic bases in DNA, leading to the formation of cyclobutane pyrimidine dimers (CPDs). These CPDs distort the DNA helix and result in characteristic C to T and CC to TT mutations—hallmarks of UV-induced skin cancers like squamous cell carcinoma and melanoma.²⁴

Although UVA is less energetic, it also causes damage. It induces CPDs and promotes oxidative stress, indirectly damaging DNA via melanin-mediated production of reactive oxygen species (ROS).²⁵ These ROS can cause single-stranded DNA breaks in key tumour suppressor genes.^25,26

When Repair Mechanisms Are Compromised

The skin has repair mechanisms to respond to photodamage, notably involving the tumour suppressor p53. However, p53 itself is frequently mutated by UV exposure, particularly at dipyrimidine sites, compromising its ability to regulate cell cycle arrest, DNA repair, and apoptosis. This dual hit—damage and impaired repair—creates a pathway for unchecked cell proliferation and cancer.^27,28

Tanning = DNA Damage

The tanning process itself is a biological response to DNA damage. In keratinocytes, UV-induced activation of p53 leads to upregulation of the pro-opiomelanocortin (POMC) gene.²⁹ The POMC polypeptide is cleaved into several products, including alpha-melanocyte-stimulating hormone (α-MSH), which signals melanocytes via the melanocortin 1 receptor (MC1R) to produce melanin.³⁰ This is the pigment that darkens the skin—what we recognise as a tan.

People with loss-of-function variants in MC1R, such as many individuals with red hair, do not tan effectively and are more prone to burning.³¹ This also highlights that the ability to tan is not a marker of skin health, but a response to genetic damage.

There’s No Such Thing as a Safe Tan

Importantly, even UV doses below the threshold for visible inflammation (sunburn) may still induce skin carcinogenesis, meaning you don’t have to burn to do harm.^6,22,32-34 This underscores a critical point: there is no safe level of tanning.

In short, every tan is a scar at the molecular level—evidence that your DNA has been damaged, your repair systems have been activated or overwhelmed, and your long-term risk of skin cancer has increased.

The Safer Tan: What Fake Tans Do (and Don’t) Offer

Sunless tanning products—like lotions, mousses, and sprays—offer a UV-free way to achieve a bronzed look. Most rely on dihydroxyacetone (DHA), a colourless sugar that reacts with proteins in the top layer of skin to temporarily darken its appearance. Importantly, this is a surface-level reaction only; it doesn’t involve UV exposure or increase skin cancer risk.³⁵

But there’s a crucial caveat: fake tans offer no protection against UV radiation. Even with a perfect faux glow, you still need to apply sunscreen. That can be a challenge, since some oil-based sunscreens may cause streaking or fading, leading some people to avoid them altogether. While there is limited research on how many people use both fake tan and sunscreen, anecdotal evidence suggests some may skip sunscreen simply because their tan makes them feel protected. Worse still, fake tan can mask early signs of sunburn, such as redness, especially on already tanned or darker skin, delaying reapplication or shade-seeking, and increasing the risk of deeper damage.

Sunscreen and Public Health: Progress with Room to Grow

Public health campaigns have played a major role in shifting attitudes toward sun exposure. Iconic efforts like Australia’s “Slip, Slop, Slap” and the UK’s SunSmart helped embed sun safety into mainstream culture, encouraging behaviours like wearing hats, using sunscreen, and seeking shade. More recently, influencers and public figures have amplified these messages, making sunscreen use more visible, especially among younger audiences.

Alongside cultural shifts, regulation has made a tangible impact. Several countries, including Australia, New Zealand, and the UK, banned commercial tanning bed use by minors.³⁶ Where such restrictions have been introduced, adolescent use of tanning beds has dropped by up to 85%, and adult use has fallen by 50%.^8,9

To build on this momentum, behavioural strategies—such as placing graphic images of skin cancer in tanning salons—may offer additional impact.³⁷ This approach, modelled on the success of image-based warnings on cigarette packaging, can enhance emotional engagement and stimulate deeper cognitive processing, making the health risks more tangible and immediate.³⁸

Sunscreen remains a vital part of sun protection. Modern formulations offer higher SPF ratings, water resistance, and eco-conscious ingredients that support both skin health and environmental safety. When used daily, sunscreen can significantly reduce the risk of melanoma and squamous cell carcinoma.^39-42

Despite all we know, sunscreen is not yet included on the World Health Organization’s List of Essential Medicines. However, there is an active proposal under review to add SPF 50+ broad-spectrum sunscreen to the list, specifically to support persons with albinism, who face extreme vulnerability to UV damage, particularly in low-resource settings.⁴³

Awareness Isn’t Enough—Action Is Essential

Public understanding of skin cancer has come a long way, but behaviour hasn’t always kept pace. Despite the risks, tanning beds and unprotected sun exposure remain stubbornly common. With safer alternatives and proven prevention strategies at our fingertips, now is the time to turn awareness into lasting change. Skin cancer is one of the most preventable cancers we face—let’s not waste the opportunity to prevent it.

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