Tanning Booths: Think Twice

Dr. Carla Nip-Sakamoto
Dermatologist at Queen’s Physicians Office Building

Where did you receive your schooling and training?

I attended medical school at John A. Burns School of Medicine, and I completed my dermatology training at UCLA.

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Dr. Carla Nip-Sakamoto

How long have you been in practice?

Twenty-two years. I am also current president of American Cancer Society board of directors for Hawaii Pacific.

What got you interested in dermatology?

It’s very visual and I think I’m well-suited to that. I like the interactive aspects and the opportunity to develop relationships. Patients are very engaged in dermatology because they feel and see what’s going on, so we can easily involve them in the diagnostics and therapeutics. If there are results, they see it. If there aren’t results, they’re back in our office.

My most important tool is my vision. I also need to feel things, and sometimes even smell things. Dermatology doesn’t rely much on diagnostic tools like X-rays, MRIs and CT-scans. We use our natural senses to make diagnoses. It’s kind of like being a detective, extracting information and then putting it all together along with the visual cues.

What area of dermatology do you specialize in?

Dermatology is really evolving. When I started training in the early ’90s, the cosmetic or aesthetic parts of dermatology were in their beginning stages. We were talking about anti-aging skincare regimens, and procedures like chemical peels. Lasers were getting their start. Now it’s in full bloom. I enjoy procedural dermatology, however, I also love medical dermatology because it’s really the exciting, academic, intellectual part of our specialty ― collecting information and digesting it to get an answer.

There’s definitely a lot going on in skin rejuvenation and the quest to look younger. We live in a youth-driven culture and people are trying to do what they can. We can do things that are not too invasive to enhance how one looks and therefore feels. You don’t always have to do surgery.

Last year, legislation passed to restrict tanning-device use to those 18 and older. Why now?

We’re definitely seeing an increase in skin cancer. Of particular concern is melanoma, because that’s a deadly form of cancer. We have to be aware of and appreciate all of the contributing factors, and we know that ultraviolet light is a major contributor to skin cancer. In Hawaii, we live with UV light all the time, so we have to take preventative measures. It’s counterproductive to do things to your skin that are known to be carcinogenic. We spend a lot of time educating our patients about how to prevent getting overexposed ―indoor and outdoor tanning doesn’t make sense.

We’re just at the beginning of this whole movement. What’s really exciting is that the legislation invigorates public discussion. Now that we have legislative action in Hawaii, there are more people interested. That’s important, because we’re a sunny state, we have year-round sun.

Are tanning beds worse for minors?

Minors are particularly vulnerable because their decisions about UV exposure have long-term effects that are not seen for 20 to 30 years. Sometimes young people, especially teenagers, can be more impulsive. Whether it’s tanning, tattooing or body piercing, they might make a decision on a whim and later regret it. I have patients who tanned when they were younger and totally regret it now.

The legislative bill is important because of the increase in skin cancer incidence, and minors are particularly at risk, especially with misleading claims that tanning salons often promote: You need this to improve your vitamin D synthesis, or this will prime your skin so you can go out in the sun in the summer and not get burned. These claims are not true. Vitamin D synthesis requires UVB light. Tanning devices don’t emit UVB, they emit UVA, so they really aren’t involved in the spectrum of Vitamin D synthesis.

It would be great if we had regulatory measures to protect everyone. For example, warning signs on machines and information on consent forms, so people visiting tanning establishments are fully informed of what they potentially are doing to their skin.

Is there a safe way or age to use a tanning booth?

No.

Do tanning booths affect the skin the same way sun exposure does?

Tanning booths utilize ultraviolet A light, and we know ultraviolet A light contributes to aging of the skin and also to the development of skin cancer. Ultraviolet B also contributes to skin cancer, and is not emitted by tanning machines.

With natural sunlight, you’re exposed to UVA and UVB, so you’re getting bombarded by two areas in the spectrum that cause skin cancer. UVA penetrates deeper into the skin than UVB does, so it’s potentially a scarier part of the spectrum.

Is skin cancer more prevalent in Hawaii?

There are statistics, but unfortunately our incidence is probably underestimated because it requires reporting to our tumor registry and not all skin cancers are reported. The only reportable cancer is melanoma. Basal cell and squamous cell carcinomas, the most common skin cancers, do not require reporting, so our incidence is underestimated.

It might appear that Hawaii doesn’t have a huge problem, but we do. If we were to report all the basal cells, squamous cells and melanomas that all Hawaii practitioners remove, we would appreciate the magnitude of this health issue. Not a day goes by that we don’t see a skin cancer in my office.

What are some tips for keeping skin cancer free?

We recommend daily sun-screen on all exposed skin. It’s always a challenge to put it on legs and forearms. Most people are good about their faces and necks. Use SPF 30 or better. Reapply every two hours if you’re outdoors for any length of time for activities.

Protective clothing works really well, particularly if it has UPF (which is like SPF) ratings, but any degree of coverage is better than none. Even if you wear something that’s not UPF-rated, you’re still getting some protection.

Avoid midday hot sun. If you’re an avid surfer, you should surf in the morning or late afternoon. You’re getting sun even while driving to and from work. UVA passes through glass, though UVB is efficiently blocked. If you spend half an hour to 45 minutes coming in from Mililani and then the same amount of time driving home, you’re getting more than an hour of sun every day.

Anything else you’d like to mention?

It’s really important to impress upon our youths about early protection. The sun and UV light are environmental elements that take many years to manifest damage. You could have the exposure as a teen or young adult but not have a skin cancer until you’re in mid-life. Parents are well-informed now and can start off kids with good sun safety habits, but you’ve got to start those habits early in life. Parents are wonderful role models and can teach healthy living by example.

For more information, call 595-7500.