What is sun protection?

Sun protection is simply guarding a body from the adverse effects of sunlight. Aside from the hazards of heat, the sun poses the danger of sunburn, which can permanently damage the skin and cause skin cancer, precancerous changes in the skin, as well as premature wrinkling and signs of aging. Exposure to ultraviolet rays from the sun is a known risk factor for the development of both melanoma and non-melanoma skin cancers.

How is sunburn best prevented?

The best ways to avoid sunburn are to

limit time in the sun, especially between peak sunlight hours of 10 a.m. and 3 p.m.;

wear protective clothing, including

a broad-brimmed hat,

a shirt with sleeves that cover the arms, and

a long skirt or pants with long legs; and

use a protective sunscreen to minimize the penetration of the sun's ultraviolet (UV) rays.

What is sunscreen?
Sunscreen is any substance or material that protects the skin from UV radiation. Sunscreens are available in the forms of topical lotion, cream, ointment, gel, or spray that can be applied to the skin; a salve or stick that can be applied to the lips, nose, and eyelids; a moistener in towelettes that can be rubbed against the skin; sunglasses that protect the eyes; certain types of sunprotection clothing; and film screen that can be affixed to the windows of a car, room, or office.

What is meant by SPF?

SPF, an abbreviation for sun-protection factor, is a number such as 15, 30, or 50 that indicates the degree of sunburn protection provided by sunscreens. SPF is related to the total amount of

sun exposure rather than simply the length of sun exposure. It is a common mistake to assume that the duration of effectiveness of a sunscreen can be calculated simply by multiplying the SPF by the length of time it takes for him or her to suffer a burn without sunscreen, because the amount of sun exposure a person receives is dependent upon more than just the length of time spent in the sun. The amount of sun exposure depends upon a number of factors including the length of exposure, time of day, geographic location, and weather conditions. A common mistake is applying too little sunscreen, which can drastically reduce the effective SPF of the product. About 1 ounce (5-6 teaspoons) of sunscreen is recommended to cover the entire body. Further, sunscreen must be reapplied every two hours when staying outdoors for a prolonged period of time. Sunscreen should also be applied at least 30 minutes before going outdoors. People with sensitive skin who burn quickly and must spend a lot of time outdoors should always apply a sunscreen with an SPF of 30 or more.

Are all sunscreens equally effective against UV radiation?

No. Some sunscreens protect against only one type of ultraviolet radiation: ultraviolet-B (UVB). Others protect against both types of ultraviolet radiation that reach earth's atmosphere from the sun: ultraviolet-B and ultraviolet-A (UVA). Sunscreens that protect against both UVA and UVB, and are thus classified as "broad spectrum," are recommended for everyone.

How do sunscreens work, and which sunscreen ingredients protect against both types of UV radiation?
Physical sunscreens containing zinc oxide or titanium dioxide protect against UVB and UVA. However, zinc oxide blocks more UV radiation than titanium dioxide and, therefore, is the preferred ingredient. Some chemical sunscreens can also block UVA rays. Octocrylene is a chemical known as a cinnamate that has both UVA- and UVB-absorbing properties, and the benzophenones (such as avobenzone) can also absorb both UVA and UVB rays. In July 2006, the U.S. FDA approved an over-the-counter (OTC) sunscreen preparation known as Anthelios SX that contains the UVA filter ecamsule. Ecamsule is a potent UVA-blocking compound that has been sold in sunscreen products in Canada and Europe since 1993.

How should skin sunscreens be applied?

It's a good general rule to apply a sunscreen very liberally. Anyone who skimps won't receive full protection. The sunscreen should be applied about a half hour before going outside to allow time for the sunscreen to soak in and take effect.

Do water or perspiration wash off sunscreen?

Yes. Therefore, sunscreen should be reapplied at least every two hours when staying outdoors for a prolonged period and after swimming, bathing, perspiring heavily, or drying off with a towel or handkerchief. Water- and perspiration-resistant sunscreens are available. However, even their protection will not last indefinitely.

Can sunscreens cause a skin reaction?

Yes. In some people, sunscreens containing PABA (para-aminobenzoic acid) can actually heighten the risk of suffering from sunburn. Other ingredients in sunscreens may also increase the risk of a skin reaction in certain people. Anyone can determine the suitability of a particular sunscreen without risk of serious harm by: 1. clothing his or her body fully except for a small patch of skin; and then

2. applying the sunscreen to the skin patch and exposing it to sunlight.

3. If a reaction occurs, the user should not use that product. He or she should try another product.

Should everyone use sunscreen protection?

As a general rule, babies 6 months of age or younger should not have sunscreen applied to their skin because their bodies may not be capable of tolerating the chemicals in sunscreens. Instead, they should be kept away from sun exposure. Everyone over 6 months of age should use a sunscreen regularly unless they and their doctors decide it would be better to protect the skin in other ways.

Can the labels on sunscreen products be trusted in the U.S.?

In the past, no. In an effort to make sunscreen labels more reliable and useful, the Food and Drug Administration (FDA) in 1999 issued new labeling regulations for over-the-counter sunscreens. According to the new FDA guidelines, sunscreen labels will be prohibited from making claims that are considered unproven or absolute such as "waterproof" and "all-day protection." The FDA will also no longer permit a product to be called "sunblock." (Sunscreens don't block out all of the sun's rays.) Manufacturers must also list the active sunscreen ingredients in their products on the label.

Do all tanning products contain sunscreens?

No, some don't. Tanning products that don't contain sunscreen will be required by the FDA to carry a warning label alerting consumers to the dangers of unprotected sunbathing.

What kind of sunglasses should be worn?

Only those that provide 100% protection against UV radiation, as stated on the label at the time of purchase, should be worn.

Is sunscreen protection necessary in the winter?

Yes, UV radiation, though not as intense in the winter, still poses a threat, especially when rays reflect off snow. There is no safe time of year when it comes to UV radiation.

Are a good sunscreen and sunglasses enough?

No, they are only one part of a complete sun-protection program. An effective program also includes limiting sun exposure and wearing protective clothing.

SPF vs UPF Both SPF (Sun Protection Factor) and UPF (Ultraviolet Protection Factor) are standards used to measure sunburn protection. SPF, the standard used to measure the effectiveness of sunscreens, has been around for many years. The UPF system is relatively new and was created specially for sun protective fabrics. At first, American sun protective fabrics were rated using the SPF standard until the FTC finalized the UPF standard we have today. Use of the UPF standard is voluntary so some sun protective fabric manufactures still use the SPF system. SPF Rating System SPF measurements are done on human subjects. SPF, is a gauge of how much time a person can be exposed to the sun before getting burned. For example, if you burn in 10 minutes without sunscreen and you apply a liberal dose of sunscreen with a SPF number of 15, you should be protected from a sunburn for 150 minutes. Although sunscreens with identical SPF numbers give you equivalent sunburn protection from UVB rays, no sunscreen product screens out all UVA rays. Some may advertise UVA protection, but the current SPF standard does not measure the amount of UVA protection. Although experts still believe that UVB is responsible for much of the skin damage caused by sunlight --especially sunburn-- UVA may be an important factor in other types of sun damage, including premature aging, wrinkles and the development of skin cancers. UPF Rating System

UPF measurements of fabrics are generally tested by spectrophotometer equipment and are not tested using human subjects. The UPF rate indicates how much of the sun's UV radiation is absorbed by the fabric. For example, a fabric with a UPF rating of 50 only allows 1/50th of the sun's UV radiation to pass through it. This means that this fabric will reduce your skin's UV radiation exposure by 50 times (98% UV block) in areas where the skin is protected by the fabric. One big advantage of the UPF standard is that both UVB AND UVA are measured. The table below illustrates the different UPF protection ranges and the percentage UV blocked.

Protection Category
Good UV Protection Very Good UV Protection Excellent UV Protection

UPF Range
15 - 24 25 - 39 40 - 50+

UPF Values Allowed on Labels

15 and 20 25, 30 and 35 40, 45, 50 and 50+

Approximate % UV Blocked
93.3% - 95.8% 96.0% - 97.4% 97.5% - 98.0%

Terlalu lama berada di bawah sinar matahari, tentu akan membuat kulit hitam dan kusam. Cegah proses penghitaman oleh sinar matahari, dengan menggunakan kosmetika yang mengandung SPF, atau anti UVA dan anti UVB. Kosmetika yang mengandung SPF, menurut dr. Maria dari Natasha Skin Care, artinya mengandung zat pelindung dari sinar matahari. Biasanya, besaran daya lindung ini dipakai istilah Sun Protection Factor (SPF). "Sun screen dan sunblock sebenarnya cuma istilah saja. Fungsi dan sifatnya sama, untuk melindungi kulit dari pengaruh buruk sinar matahari." Pada beberapa kosmetik seperti lotion, foundation, pelembap, moisturizer, bahkan lipstik biasanya tercantum besaran SPF ini. Misalnya SPF 15, SPF 36, SPF 50, dan lainnya. Istilah medisnya, ujar Maria, pembandingan besaran angka itu disebut dosis eritema minimal. "Artinya, besarnya energi sinar mahatari terkecil yang bisa menyebabkan kulit merah-merah." Misalnya, jika kulit tanpa sun screen terkena sinar matahari selama 5 menit, akan langsung timbul merah-merah. Jika pakai pelembap SPF 15 atau SPF 18, tetap akan timbul kemerahan tapi dengan waktu lebih lama (jika 5 menit: 15 atau 18 x 5, hasilnya adalah durasi bagi kulit mulai memerah). Sehingga, fungsi SPF ini bisa lebih memperlama proses kemerahan pada kulit. TAK BERBANDING LURUS SPF 15 merupakan daya lindung yang paling kecil, dan yang paling tinggi bisa mencapai SPF 40/ SPF 50 atau 60. Namun, besaran SPF tak berbanding lurus dengan daya proteksinya. Jika SPF 15 bisa melindungi kulit sampai 94 persen, bukan berarti yang SPF 30 memproteksi dua

kalinya dari 94 persen. Hanya fungsi melindungi kulitnya saja yang lebih lama. Palinmg-paling hanya sampai 97 persen. "Yang jelas, jika SPF-nya sudah lebih dari 40-50, daya proteksinya hanya naik 1 persen dari angka di bawahnya. Daya lindung SPF 60 pun, sebenarnya tak jauh berbeda dengan SPF 30." Untuk di daerah tropis seperti Indonesia, bagi yang jarang ke luar rumah cukup pakai kosmetik SPF 15 saja. Tapi bagi mereka yang lebih sering melakukan aktifitas out door, paling tidak harus pakai SPF 30. Sementara, UVA dan UVB adalah perbedaan panjang gelombang sinar ultra violet. Secara medis, kata Maria, perbedaan UVA dan UVB hanya pada efek ke kulitnya. "Kulit, memiliki beberapa lapisan. Nah, UVA, efek sinarnya akan menembus sampai ke lapisan bawah atau dermis, yang lebih dalam. Efeknya bisa membuat flek hitam dan kerut-kerut." Sedangkan UVB, efek tembus sinarnya tak sedalam UVA, melainkan hanya sebatas sampai ke lapisan atas atau basal epidermis (lapisan epidermis). Efeknya hanya menggelapkan kulit saja. Jika berlama-lama berada di bawah sinar matahari, kulit akan menghitam. Sehingga, produk kosmetik atau perawatan tubuh yang mengandung anti UVB atau UVA, akan membantu menghindari efek-efek buruk tadi.

AMERICAN ACADEMY OF DERMATOLOGY Sunscreens

Q. Who needs to use sunscreen? A. In a word: Everyone! More than 3.5 million skin cancers are diagnosed in more than 2 million people annually.1 Many studies have found an association between sunburns and enhanced risk for melanoma, the deadliest form of skin cancer.2 The Food and Drug Administration (FDA) and the American Academy of Dermatology recognize six skin categories:3,4

Skin type I II III IV

Sun history Always burns easily, never tans, extremely sun-sensitive skin. Usually burns easily, tans minimally, very sun-sensitive skin. Sometimes burns, tans gradually to light brown, sun-sensitive skin. Burns minimally, always tans to moderate brown, minimally sun-sensitive skin. Rarely burns, tans well, sun-insensitive skin. Never burns, deeply pigmented, sun-insensitive skin.

V VI

The American Academy of Dermatology recommends that, regardless of skin type, a broad-spectrum (protects against UVA and UVB rays), water-resistant sunscreen with a Sun Protection Factor (SPF) of at least 30 should be used year-round. Q: What are UVA and UVB rays? A: Sunlight consists of two types of harmful rays: ultraviolet A (UVA) rays and ultraviolet B (UVB) rays. UVA rays (which pass through window glass) penetrate deeper into the dermis, the thickest layer of the skin. UVA rays can cause suppression of the immune system, which interferes with the immune system's ability to protect you against the development and spread of skin cancer. UVA exposure also is known to lead to signs of premature aging of the skin such as wrinkling and age spots. The UVB rays are the sun's burning rays (which are blocked by window glass) and are the primary cause of sunburn. A good way to remember it is that UVA rays are the aging rays and

UVB rays are the burning rays. Excessive exposure to both forms of UV rays can lead to the development of skin cancer. The United States Department of Health and Human Services has declared ultraviolet (UV) radiation from the sun and artificial sources, such as tanning beds and sun lamps, as a known carcinogen (cancer-causing substance).5 Q: When should sunscreen be used? A: Sunscreen should be applied every day to exposed skin, and not just if you are going to be in the sun. UVB rays cannot penetrate glass windows, but UVA rays can, leaving you prone to these damaging effects if unprotected. For days when you are going to be indoors, apply sunscreen on the areas not covered by clothing, such as the face and hands. Sunscreens can be applied under makeup, or alternatively, there are many cosmetic products available that contain sunscreens for daily use. Sun protection is the principal means of preventing premature aging and skin cancer. It's never too late to protect yourself from the sun and minimize your future risk of skin cancer. Don't reserve the use of sunscreen only for sunny days. Even on a cloudy day, up to 80 percent of the sun's ultraviolet rays can pass through the clouds. In addition, sand reflects 25 percent of the sun's rays and snow reflects 80 percent of the sun's rays.6 Q: How much sunscreen should be used, and how often should it be applied? A: Sunscreens should be applied to dry skin 15 to 30 minutes BEFORE going outdoors. When using sunscreen, be sure to apply it to all exposed areas and pay particular attention to the face, ears, hands and arms. Coat the skin liberally and rub it in thoroughly most people apply only 25 to 50 percent of the recommended amount of sunscreen.7 One ounce, enough to fill a shot glass, is considered the amount needed to cover the exposed areas of the body properly. Don't forget that lips get sunburned, too, so apply a lip balm that contains sunscreen with an SPF of 30 or higher. Sunscreens should be reapplied about every two hours, or after swimming or perspiring heavily. Even so-called "water-resistant" sunscreens may lose their effectiveness after 40 minutes in the water. Sunscreens rub off as well as wash off, so if you've towel-dried, reapply sunscreen for continued protection. Also, there are a number of combination cosmetic products, such as moisturizers that contain sunscreen, but it is important to remember that these products also need to be reapplied to achieve continued UV protection. Q: What type of sunscreen should I use, and what ingredients should I look for? A: There are so many types of sunscreen that selecting the right one can be quite confusing. Sunscreens are available in many forms, including ointments, creams, gels, lotions, sprays and

wax sticks. The type of sunscreen you choose is a matter of personal choice. Creams are best for individuals with dry skin, but gels are preferable in hairy areas, such as the scalp or male chest. Sticks are good around the eyes. Creams typically yield a thicker application than lotions and are best for the face. There also are sunscreens made for specific purposes, such as sensitive skin and for use on babies. Ideally, sunscreens should be water-resistant, so they cannot be easily removed by sweating or swimming, and should have an SPF of 30 or higher that provides broad-spectrum coverage against both UVA and UVB light. Ingredients to look for on the sunscreen label to ensure broadspectrum UV coverage include:

Avobenzone Cinoxate Ecamsule Menthyl anthranilate Octyl methoxycinnamate Octyl salicylate Oxybenzone Sulisobenzone Titanium dioxide Zinc oxide

Q: Can I use the sunscreen I bought last summer, or do I need to purchase a new bottle each year? Does it lose its strength? A: Unless indicated by an expiration date, the FDA requires that all sunscreens be stable and at their original strength for at least three years. You can use the sunscreen that you bought last summer, but keep in mind that if you are using the appropriate amount, a bottle of sunscreen should not last very long. About 1 ounce of sunscreen, enough to fill a shot glass, is considered to be the amount needed to cover the exposed areas of the body properly. Q: What is an SPF? A: SPF stands for sun protection factor. Sunscreens are rated or classified by the strength of their SPF. The SPF numbers on the packaging can range from as low as 2 to greater than 50. These numbers refer to the product's ability to deflect the sun's burning rays (UVB). A sunscreen's SPF rating is calculated by comparing the amount of time needed to produce a sunburn on sunscreen-protected skin to the amount of time needed to cause a sunburn on unprotected skin. For example, if a sunscreen is rated SPF 2 and a person who would normally turn red after 10 minutes of exposure in the sun uses it, it would take 20 minutes of exposure for the skin to turn red. A sunscreen with an SPF of 15 would allow that person to multiply that initial burning time by 15, which means it would take 15 times longer to burn, or 150 minutes. Even with this

protection, sunscreen photo degrades (breaks down) and rubs off with normal wear, so it needs to be reapplied approximately every two hours. Dermatologists strongly recommend using a broad-spectrum (UVA and UVB protection) waterresistant sunscreen with an SPF of 30 or greater year-round for all skin types. This will help protect against sunburn, premature aging (e.g., age spots and wrinkles) and skin cancer. Q: Does the SPF tell how well a sunscreen protects against UVA or UVB rays? A: The SPF number on sunscreens only reflects the product's screening ability for UVB rays. At present, there is no FDA-approved rating system that identifies UVA protection. Scientists are working to create a standardized testing system to measure UVA protection. Q: Does SPF 30 have twice as much sun protection as SPF 15? A: UVB protection does not increase proportionately with a designated SPF number. For example, an SPF of 30 screens 97 percent of UVB rays, whereas an SPF of 15 screens 93 percent of UVB rays, and an SPF of 2 screens 50 percent of UVB rays. However, inadequate application of sunscreen may result in a lower SPF than the product contains. Whichever SPF you choose, wearing sunscreen should not provide a false sense of security about protection from UVB exposure. No sunscreen can provide 100 percent UVB protection. Using a higher SPF provides greater UVB protection than a lower SPF, but it does not mean that you should stay out in the sun longer. Q: Is sunscreen application all I need to do to protect myself from the sun? A: Sun exposure is the most preventable risk factor for skin cancer, including melanoma.8,9 You can have fun in the sun and decrease your risk of skin cancer. Here's how to Be Sun Smart:

Generously apply a broad-spectrum, water-resistant sunscreen with a sun protection factor (SPF) of at least 30 to all exposed skin. "Broad-spectrum" provides protection from both ultraviolet A (UVA) and ultraviolet B (UVB) rays. Reapply about every two hours, even on cloudy days, and after swimming or sweating. Wear protective clothing, such as a long-sleeved shirt, pants, a wide-brimmed hat and sunglasses, where possible. Seek shade when appropriate, remembering that the sun's rays are strongest between 10 a.m. and 4 p.m. If your shadow is shorter than you are, seek shade. Use extra caution near water, snow and sand because they reflect the damaging rays of the sun, which can increase your chance of sunburn. Get vitamin D safely through a healthy diet that may include vitamin supplements. Don't seek the sun.10 Avoid tanning beds. Ultraviolet light from the sun and tanning beds can cause skin cancer and wrinkling. If you want to look tan, consider using a self-tanning product, but continue to use sunscreen with it. Check your birthday suit on your birthday. If you notice anything changing, growing or bleeding on your skin, see a dermatologist. Skin cancer is very treatable when caught early.

Q: Is there a safe way to tan? A: There is no safe way to tan. A tan damages the skin. Tanning occurs when ultraviolet rays

penetrate the epidermis, the skin's outer layer causing the production of melanin as a response to the injury. Chronic exposure to ultraviolet light, both natural and artificial, results in a change in the skin's texture, causing wrinkling and age spots. Thus, tanning to improve appearance is ultimately selfdefeating. Every time you tan, you damage your skin and this damage accumulates over time. This accumulated damage, in addition to accelerating the aging process, also increases your risk for all types of skin cancer. Q: Are tanning beds a safer way to tan? A: In spite of claims that tanning beds offer "safe" tanning, indoor tanning equipment, which includes all artificial light sources such as beds, lamps, bulbs, booths, etc., emits UVA and UVB radiation. The amount of the radiation produced during indoor tanning is similar to the sun and, in some cases, may be stronger.11,12 Studies have demonstrated that exposure to UV radiation during indoor tanning damages the DNA in the skin cells. Also, excessive exposure to UV radiation during indoor tanning can lead to skin aging, immune suppression, and eye damage, including cataracts and ocular melanoma.1317

Many tanning salons are unregulated, allowing customers (especially those with fair skin that tans poorly) access to tanning beds without supervision or eye protection. The American Academy of Dermatology (Academy) opposes indoor tanning and supports a ban on the production and sale of indoor tanning equipment for non-medical purposes. The Academy supports the World Health Organization recommendation that minors should not use indoor tanning equipment because indoor tanning devices emit UVA and UVB radiation, and overexposure to UV radiation can lead to the development of skin cancer. The United States Department of Health and Human Services and International Agency for Research on Cancer panel have declared ultraviolet (UV) radiation from the sun and artificial sources, such as tanning beds and sun lamps, as a known carcinogen (cancer-causing substance). Q: How do I treat a sunburn? A: In case you forget to cover up and apply sunscreen, the resulting sunburn can be painful, as well as dangerous. Remember that you may not immediately see the effects of overexposure to the sun. It may take up to 24 hours before the full damage is visible. There are several types of burns and burn treatments. The two most common sunburns are firstdegree burns and second-degree burns. First-degree sunburns cause redness and will heal, possibly with some peeling, within a few days. These can be painful and are best treated with cool baths and moisturizers or over-thecounter hydrocortisone creams.

Avoid the use of "-caine" products (such as benzocaine), which may cause sensitivity to a broad range of important chemicals. Anti-inflammatory oral medications such as aspirin or ibuprofen may lessen the pain and discomfort associated with sunburn. Second-degree sunburns blister and can be considered a medical emergency if a large area is affected. Do not break the blisters, as they are a natural protective mechanism to heal the affected area and rupturing them delays the healing process and invites potential infection. A layer of gauze may be used to cover the area until healed. When a burn is severe, accompanied by a headache, chills or a fever, seek medical help immediately. Be sure to protect your skin from the sun while it heals and thereafter. Q: Will using sunscreen limit the amount of vitamin D I get? A: Unprotected UV exposure to the sun or indoor tanning devices is a known risk factor for the development of skin cancer. Sun exposure is responsible for vitamin D production in the skin, so wearing sunscreen will decrease the skin's production of vitamin D. Individuals who wear sunscreen and are concerned that they are not getting enough vitamin D should discuss their options for obtaining sufficient vitamin D from foods and/or vitamin supplements with their doctor.
1

Rogers, HW, Weinstock, MA, Harris, AR, et al. Incidence estimate of nonmelanoma skin cancer in the United States, 2006. Arch Dermatol 2010; 146(3):283-287. 2 Elwood JM, Jopson J. Melanoma and sun exposure: an overview of published studies. Int J Cancer (1997). 73(2):198-203. 3 Fitzpatrick TB. The validity and practicality of sun-reactive skin types I through VI. Arch Dermatol. 1988.124:869-871. 4 Sunscreen drug products for over-the-counter human use (21CFR352). Food and Drug Administration. www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfCFR/CFRSearch.cfm?CFRPart=352. 5 Report on Carcinogens, Eleventh Edition (Ultraviolet Radiation Related Exposures); U.S. Department of Health and Human Services, Public Health Service, National Toxicology Program. 6 Global Solar UV Index. World Health Organization. www.who.int/uv/publications/en/UVIGuide.pdf. 7 Neale, R, Williams, G, Green, A. Application patterns among participants randomized to daily sunscreen use in a skin cancer prevention trial. Arch Dermatol. 2002 Oct; 138, 1319-1325. 8 Robinson, JK. Sun Exposure, Sun Protection and Vitamin D. JAMA 2005; 294: 1541-43. 9 American Cancer Society. Cancer Facts and Figures 2010. 10 Hemminki K, Dong C. Subsequent cancers after in situ and invasive squamous cell carcinoma of the skin. Arch Dermatol 2000;136:647-51. 11 Hornung RL, Magee KH, Lee WJ, Hansen LA, Hsieh YC. Tanning facility use: are we exceeding the Food and Drug Administration limits? J AM Acad Dermatol. 2003 Oct;49(4):65561.

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Miller, SA, Hamilton, SL, Wester, UG, Cyr, WH. An analysis of UVA emissions from sunlamps and the potential importance for melanoma. Photochem Photobiol 68(1998), 63-70. 13 Whitmore SE, Morison, WL, Potten CS, Chadwick C. Tanning salon exposure and molecular alterations. J Am Acad Dermatol 2001;44:775-80. 14 Piepkorn M. Melanoma genetics: an update with focus on the CDKN2A(p16)/ARF tumor suppressors. J Am Acad Dermatol. 2000 May;42(5 Pt 1):705-22; quiz 723-6. 15 Vajdic CM, Kricker A, Giblin M, McKenzie J, Aitken JF, Giles GG, Armstrong BK. Artificial ultraviolet radiation and ocular melanoma in Australia. Int J Cancer. 2004 Dec 10;112(5):896900. 16 Walters BL, Kelly TM. Commercial tanning facilities: a new source of eye injury. Am J Emerg Med 1987;120:767-77. 17 Clingen PH, Berneburg M, Petit-Frere C, Woollons A, Lowe JE, Arlett CF, Green MH. Contrasting effects of an ultraviolet B and an ultraviolet A tanning lamp on interleukin-6, tumour necrosis factor-alpha and intercellular adhesion molecule-1 expression. Br J Dermatol. 2001 Jul;145(1):54-62.