Fashion Changes May Explain Increase in Serious Skin Cancer

Melanoma incidence increased as clothing and leisure time changed over last century

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) The porcelain skin and full-coverage dresses of the early 1900s have given way to the deep tans and bikinis popular today. Changing perceptions of beauty and fluxes in fashion trends may explain increases in cases of melanoma.

As fashion choices have increased the amount of skin exposed to the sun, rates of melanoma skin cancer may have grown in step, a new study suggests.

And while broad socioeconomic trends may also be responsible for increasing melanoma, limiting sun exposure may significantly reduce risk.

David Polsky, MD, PhD, and colleagues reviewed clothing styles, relevant medical practices, and other social and economic measures to understand long-term increases in melanoma.

Melanoma is the most serious form of skin cancer. Surgery is a primary treatment, but radiation and chemotherapy are also used. Sun exposure is a primary driver of skin cancer.

Dr. Polsky, of the Ronald O. Perelman Department of Dermatology at New York University-Langone, and team estimated the change in skin area exposed to sun by changing clothing tastes.

The study authors explained that, in the early 20th century, tan skin was associated with low-paid people who worked outside. That stigma translated into a preference for light-colored skin.

Later, people adopted the belief that sunshine had medical benefits — some thought it could treat tuberculosis, for instance. That, combined with an increase in leisure time, corresponded with people wearing more swim and sports clothing that showed more skin.

The rise in travel and leisure helped swing preferences toward tan skin and away from light skin, the authors wrote.

“Attitudes and behaviors shape exposures,” the authors wrote. “More skin, more sun and more tan lead to more melanoma.”

Victoria Sharon, MD, DTMH, Assistant Professor of Dermatology & Dermatologic Surgery at the University of California Davis Medical Center echoed that point.

"Point blank: Tanned skin is damaged skin. Tanning is a result of exposure to UVA and UVB radiation from the sun’s rays. Since ultraviolent light is a carcinogen, there is no safe amount of sun tanning," Dr. Sharon said.

"A person’s risk of melanoma and other skin cancers increases with each tan. For instance, a recent study published in the Journal of the American Academy of Dermatology (J Am Acad Dermatol. 2014 May;70(5):847-57) demonstrated a significantly increased risk of developing melanoma with exposure to just 10 indoor tanning sessions, which can be extrapolated to also pertain to outdoor sun tanning," she said.

"The best way to reduce the risk of melanoma and other ultraviolet-associated skin cancers is to avoid ultraviolet exposure between the hours of 10 am and 4 pm, during which the sun’s rays are at their maximum intensity," Dr. Sharon said.

"As complete sun avoidance may be impractical for everyone, I recommend that my patients wear sun protective clothing throughout the day (including a wide brim hat), apply sunscreen with an SPF of at least 30 every morning prior to leaving the house with frequent re-application, and to reduce daily sun exposure when possible," she said.

Dr. Polsky and colleagues found records from 1950 indicating melanoma rates of three cases per 100,000 men and women. In 1970, there were 9.2 cases of melanoma per 100,000 men and 7.6 cases per 100,000 women, the authors noted.

“This increase in melanoma incidence occurred in parallel with changes in fashion, travel, and leisure that resulted in increased skin and [ultraviolet light] exposure,” the authors wrote.

The authors tracked the percentage of skin exposed by decade. In 1950, they estimated, swimwear exposed between 15 and 20 percent of skin to the sun. In 1970, swimwear exposed an estimated 60 percent of skin to the sun. That figure jumped to 80 percent by 1990.

Between 1950 and 1990, rates of melanoma grew from fewer than 5 cases per 100,000 people to about 20 cases per 100,000 people.

In response to their findings, the study authors suggested public health measures aimed at educating people on the dangers of sun exposure.

The study was published online Oct. 6 in the American Journal of Public Health.

The National Cancer Institute and Live4Life Foundation funded the research. The authors disclosed no conflicts of interest.

Review Date: 
October 14, 2014
Last Updated:
October 17, 2014