***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Although sun exposure is an established cause of cutaneous malignant melanoma , possible interactions with host factors remain incompletely understood . Here we report the first results from a large prospect i ve cohort study of pigmentation factors and sun exposure in relation to melanoma risk . METHODS The Women 's Lifestyle and Health Cohort Study included 106 379 women from Norway and Sweden who were aged 30 - 50 years in 1991 or 1992 when they completed an extensive question naire on personal characteristics and exposures . Linkages to national registries ensured complete follow-up through December 31 , 1999 . Poisson regression models were used to estimate relative risks ( RRs ) . All statistical tests were two-sided . RESULTS During an average follow-up of 8.1 years , 187 cases of melanoma were diagnosed . Risk of melanoma was statistically significantly associated with increasing body surface area ( RR for > or = 1.79 m2 versus < or = 1.61 m2 = 1.60 , 95 % confidence interval [ CI ] = 1.03 to 2.48 ; P(trend ) = .02 ) , number of large asymmetric nevi on the legs ( RR for > or = 7 nevi versus 0 nevi = 5.29 , 95 % CI = 2.33 to 12.01 ; P(trend)<.001 ) , hair color ( RR for red versus dark brown or black = 4.05 , 95 % CI = 2.11 to 7.76 ; P(trend)<.001 ) , sunburns per year at ages 10 - 19 , 20 - 29 , and 30 - 39 years ( P(trend)<.001 , P(trend ) = .03 , and P(trend ) = .05 , respectively ) , and use of a device that emits artificial light ( solarium ) one or more times per month ( P = .04 ) . CONCLUSIONS Our results confirm previous findings that hair color , number of nevi on the legs , and history of sunburn are risk factors for melanoma and suggest that use of a solarium is also associated with melanoma risk . Adolescence and early adulthood appear to be among the most sensitive age periods for the effects of sunburn and solarium use on melanoma risk . However , it may be too early to see the full effect of adult exposures in this cohort Background : The incidence of skin cancer , the most common type of cancer in the Western world , has been shown to be associated with the degree of exposure to solar radiation . However , little is known on how human skin can be protected against UV-induced DNA damage by constitutive and induced pigmentation . Objective : To study the effect of skin pigmentation induced by a sunbed-type of treatment on the formation of UV-induced DNA damage in human skin in situ . Methods : A photoproduct assay was performed in  untanned and tanned skin of healthy volunteers . Results : There is no significant difference in the induction of photoproducts between untanned and tanned skin . Conclusion : Our data demonstrate that constitutive skin pigmentation is more efficient than the induced one in protection against formation of photoproducts The incidence of cutaneous malignant melanoma ( melanoma ) and of basal cell carcinoma is still increasing in most fair-skinned population s. The fashion of intermittent exposure to solar ultraviolet ( UV ) radiations is considered the main cause of this increase . In 20 years time , tan acquisition through exposure to artificial sources of UV radiations has become frequent among fair-skinned adolescents and young adults . Modern sunbeds are powerful sources of UV radiations that do not exist in the nature , and repeated exposures to high doses of UVA constitute a new phenomenon in humans . A large prospect i ve cohort study on 106,379 Norwegian and Swedish women conducted between 1991 and 1999 has provided evidence for a significant , moderate increase in melanoma risk among regular sunbed users . Failure of past case-control studies to document with consistency the sunbed-melanoma association was probably due to a too short latency period between sunbed use and melanoma diagnosis , and to too few subjects with high total duration s of sunbed use . Regulations of sunbed installation , operation and use should become st and ardised across the 25 European Union countries . Enforcement of regulations in tanning parlours remains inadequate . In contrast , the existence of regulations is presented by many tanning salon operators as a guarantee that sunbed use is safe . We stress the need for the control of information disseminated by the " tanning industry " on suppositions that sunbed use is safer than sun exposure , and on the hypothetical health benefits of tanning . New fluorescent UV lamps are proposed that have a spectrum similar to the midday sun . Given the known association between intermittent sun exposure and melanoma , public-health authorities should reconsider the soundness of the commercialisation of these lamps BACKGROUND Indoor tanning is a popular behavior that may increase skin  cancer  risk . OBJECTIVE To examine characteristics associated with use or intention to use indoor tanning among adolescents . METHODS A telephone interview was conducted with 1273 adolescents , aged 14 to 17 years , in the Minneapolis-St Paul , Minn , and Boston , Mass , metropolitan areas . Questions included demographic and phenotypic characteristics , knowledge , attitudes , social factors , use of indoor tanning , and intention to tan indoors . RESULTS Twelve percent of boys and 42 % of girls had tanned indoors . Among nontanners , 22.4 % planned to start , and 77.2 % of tanners planned to continue tanning indoors . Nontanners and tanners at risk for future indoor tanning use were each significantly more likely to be female , less likely to use sun protection , less knowledgeable about skin cancer risks , more likely to agree that tans were attractive , and more strongly influenced by social factors compared with their low-risk counterparts . CONCLUSIONS Our data suggest that intention to tan indoors may identify a group of adolescents at risk for adopting the behavior ; prospect i ve studies are needed for confirmation BACKGROUND The relationship between cutaneous malignant melanoma and sunlamp use is examined in a Caucasian population in Connecticut , United States . METHODS Cases were diagnosed between 15 January 1987 and 15 May 1987 with a first primary cutaneous melanoma . Controls were obtained from the general population , frequency matched to cases by sex and age , through r and om digit dialling of Connecticut telephone numbers . RESULTS Of all study subjects , 141 ( 23 % ) cases and 95 ( 19 % ) controls reported ever having used  sunlamps  . The crude odds ratio ( OR ) for developing malignant melanoma after ever having used sunlamps was 1.30 ( 95 % confidence interval [ CI ] : 0.97 - 1.74 ) . This was reduced to 1.13 ( 95 % CI : 0.82 - 1.54 ) after further adjusting for cutaneous phenotype and recreational sun exposure . Those who used more than one type of sunlamp had a threefold higher risk for melanoma compared to never users . Subgroup analyses showed that sunlamp use was associated with a greater increase in risk for melanoma among those who used sunlamps at home and those who were first exposed to sunlamps prior to 1971 . The first use of sunlamps before the age of 25 showed somewhat higher risk for melanoma compared to first use later in life . CONCLUSION The current study provides limited evidence that use of sunlamps increases the risk of melanoma . For future studies , it is crucial that type of sunlamp , year of first use and amount of exposure are all taken into account . The association between melanoma and tanning with both UV-A and UV-B lamps and tanning under sunlamps early in life merits further investigation BACKGROUND The US Food and Drug Administration ( FDA ) recommends exposure limits for tanning bed use . Tanning patrons may not be following these recommendations and may be overexposed to damaging ultraviolet radiation ( UV ) . OBJECTIVE This study was conducted to assess tanning patrons ' adherence to FDA -recommended exposure limits and to measure the amount of UVA and UVB radiation emitted by tanning beds . METHODS A community-based survey was administered during routine state inspections of North Carolina tanning facilities ( n = 50 ) . At each facility , patron records were r and omly selected ( n = 483 ) for a survey of exposure records , and UVA and UVB outputs were measured for each tanning bed . RESULTS The recommended limits were exceeded by 95 % of patrons , and 33 % of patrons began tanning at the maximum doses recommended for maintenance tanning . Average tanning bed output was 192.1 W/m(2 ) UVA and 0.35 W/m(2 ) erythemally weighted UVB . CONCLUSIONS Interventions for tanning bed operators and patrons are needed to increase compliance with federally recommended exposure limits Summary Sunbed use was studied in relation to phenotype , erythema , sunscreen use and skin disease . The study population comprised 14–19 year‐old Stockholm adolescents in 60 r and omly selected classes , with 1252 students providing information . More than half ( 57 % ) reported sunbed use ± 4 times during the previous year . Skin type III dominated ( 64 % ) . Excessive exposure ( ± 10 times/year ) was not correlated to skin type .  Sunscreens  were most commonly used by sunbed users . Of all sunbed users , 44 % reported erythema . Adolescents with acne/seborrhoea , eczema or psoriasis used sunbeds more than others without skin diseases . The proportion with sunbed erythema ( 44 % ) indicates an unrecognized susceptibility to artificial ultraviolet radiation ( UVR ) among adolescents . The association between high exposure to UVR and sunscreen use stresses the importance of sunscreens being used as supplementary protection , not as a tool for tanning BACKGROUND The prevalence rates of both skin cancers and indoor tanning among the US population are high and have increased substantially in recent years . Low compliance by indoor tanning facilities with safety regulations may place consumers at greater risk of skin and ocular damage . OBJECTIVE This study quantified the level of compliance by  indoor tanning facilities  with selected federal and state regulations and recommendations . METHODS  Tanning facilities ( N = 54 ) in San Diego County , California , were visited by a confederate posing as a prospect i ve customer . Compliance with 13 regulations/ recommendations were assessed by either direct query or observation of the presence/absence of signs and warning labels . Operators ' responses to 5 risk-based questions also were noted . RESULTS No facility complied with all 13 regulations/ recommendations . Compliance with 3 protective eyewear regulations was high ( 89%-100 % ) . In contrast , compliance with  maximum tanning frequency recommendations  ( approximately 6 % ) and parental consent regulations  ( approximately 43 % ) was disturbingly low . CONCLUSION The investigators recommend instituting m and atory , comprehensive training for operators , as well as systematic compliance monitoring with enforcement of penalties for noncompliance The effects on 31 normal subjects following exposure to sunbeds containing UVA lamps with minimal UVB emission have been compared in a double‐blind study with the effects on nine control subjects of a similar exposure course three times weekly for 4 weeks to sunbeds emitting visible light . On previously untanned areas , all those subjects on active treatment developed a mild tan ; in tanned areas they all developed a moderate tan , while all control subjects developed a minimal to mild tan . The mean protection factor against later UVB‐induced erythema was 3.2±0.3 after the active course and 1.6±0.2 among the controls . Significantlsy more frequent adverse cutaneous effects for active subjects were pruritus , erythema , freckling , burning sensation , dryness and polymorphic light eruption . Cutaneous Langerhans cell numbers , and blood CD3 + ( pan T‐cell ) and CD4 + ( helper T‐cell ) lymphocyte subsets were reduced in both active and control groups . CD8 + ( cytotoxic/suppressor T‐cell ) counts were significantly reduced in both groups . The changes found in both groups seem attributable to small amounts of UVB emission from both active and control lamps UVA- and UVB-induced tans which were visually identical with each other were induced in separate sites on the lower back of 5 normal human volunteers of good tanning ability . Tanning was achieved by 4 exposures to UVA and UVB administered over an 8-day period . One week after the last exposure the protection afforded by the two types of tan against UVB-induced erythema and against UVB-induced DNA damage was measured . Protection against erythema was measured by comparison of the minimal erythema doses of UVB in tanned and untanned skin . Protection against DNA damage was assessed by comparing the numbers of endonuclease-sensitive sites in epidermal DNA extracted from biopsies taken from tanned and untanned sites exposed to the same dose of UVB . The UVB tans conferred significant protection ( mean 2.98-fold ) against UVB-induced erythema . UVA tans were not associated with significant protection ( mean 1.4-fold ) . In contrast , both UVA- and UVB-induced tans were associated with a similar reduction in yield of endonuclease-sensitive sites in epidermal DNA ( in UVA tan to 47 % and in UVB tan to 45 % of the yield in untanned skin ) . Protection conferred by the tans against erythema was therefore not paralleled by protection against DNA damage 
    Output:
    
The evidence does not support a protective effect of the use of sunbeds against damage to the skin from subsequent sun exposure .