It wasn't until Lilley was in medical school and learned about the DNA mutations that form after exposure to ultraviolet light that she began to feel nervous. Still, she thought, "I'm indoors working all the time. I'm not going out much. This is my only indulgence. How much can it hurt me?"
At first the little mole on a breast didn't worry her. She was working 80 hours a week as a pediatrician at Children's Hospital of Philadelphia and acknowledges she didn't have much time to think about herself: "I was too busy taking care of sick children."
But over time, the little mole began to look different. The changes were subtle: It seemed larger, and the edges became more ragged. Finally, Lilley was alarmed enough to have a biopsy done in her dermatologist's office. The diagnosis was malignant melanoma.
On an average day, more than a million people in this country tan in tanning salons, according to the American Academy of Dermatology. Nearly 70 percent of tanning salon patrons are Caucasian girls and women primarily between the ages of 16 and 29, and of the 28 million people who tan indoors every year, 2.3 million are teenagers.
Bruce Brod, clinical associate professor of dermatology at the University of Pennsylvania, is outraged by this. "The numbers of young women diagnosed with malignant melanoma has increased every year for the past 12 years," he says, "correlating with the proliferation of tanning salons. Women are presenting with deeper melanoma and lymph node involvement. One person dies from melanoma every hour."
The Wolff Tanning Salon was the first in this country, opening in 1978 in Arkansas; the concept quickly grew in popularity as a bronzed body became associated with glamour and sex appeal. Today, there are 18,000 professional tanning facilities in the United States, according to John Overstreet, executive director of the Indoor Tanning Association, and an additional 30,000 or so in gyms, spas, nail and hair salons, and even in laundromats.
The industry is classified by the Food and Drug Administration as Class One, the least restrictive category, putting it, says the dermatology academy, in the same benign group as Band-Aids and tongue depressors.
Lilley remembers her first time. "I walked into this beauty parlor with an adjoining tanning salon. There were several booths, each containing a tanning bed. A sign read, 'This bed has been sanitized,' but there was a bottle of a simple green solution so you could spray it some more if you wanted to.
"I fished a pair of goggles out of a bowl of disinfectant and was given an accelerant, a lotion to speed the process. The lady who owned the place assured us - my mom and me - it was safe. There was one employee, a high school student getting less than minimum wage to keep things clean. There was something that looked like an oven timer over the bed, and you did all the regulation yourself."
The radiation that tanning equipment emits is similar to that generated by the sun - 95 percent UVA rays and 5 percent UVB rays - but much more intense. Five to 10 minutes (depending on the equipment) in a tanning bed is roughly equivalent to a half-hour in the sun on a mid-July afternoon.
Tanning in the salons is not expensive, maybe $2 a minute or even less for discount packages, and the pleasing results are instant. The long-term price, according to a body of medical experts, may be lethal.
The World Health Organization has declared indoor tanning devices to be cancer-causing agents, in the same category as tobacco. It cites studies revealing a 75 percent increase in the risks of melanoma in those who have been exposed to ultraviolet radiation from indoor tanning. And a study from the Dartmouth College of Medicine reports that tanning salon users have increased risks of both squamous and basal cell carcinoma.
The American Academy of Dermatology vigorously opposes indoor tanning and supports a ban on the production and sale of indoor tanning equipment for nonmedical purposes. The American Academy of Pediatrics urges that minors be prohibited from using tanning salons.
"Sensible sun exposure is essential for everyone," insists Michael F. Holick, professor of medicine, physiology, and biophysics at Boston University Medical Center. "Those who don't get [enough sun] are deficient in Vitamin D, which puts them at risk of such illnesses as Type One diabetes, osteoporosis, and cancer."
Holick, author of The Vitamin D Solution, conducted a study of 40 adults, comparing those who visited tanning salons once a week with a control group that did not. "The tanners had robust levels of Vitamin D; the non-tanners did not," he says.
Nonetheless, Holick is not a champion of tanning salons. "There are other ways to make Vitamin D," he says. His message: Take Vitamin D supplements - 1,000 international units a day for children beginning at age 1 and 2,000 for adults. Eat more wild salmon; an average serving has from 500 to 1,000 Vitamin D units. Spend three to 10 minutes a day in the sun if possible.
The time a person needs depends on the latitude, the time of day (rays are strongest between 10 a.m. and 3 p.m.), season of the year, and degree of skin pigmentation. Those with pale skin and freckles may need less time; darker-skinned people would need more.
If someone prefers to use a tanning bed, Holick recommends once or twice a week for half the amount of time suggested by the manufacturer, with the face bathed in sunblock and the eyes protected by goggles. He does not advocate tanning salons for anyone under 18.
"Taking away from teens the option to tan indoors will not stop them from sun tanning," counters the tanning association's Overstreet. "It will only send them outdoors to an uncontrolled environment, with no supervision, no parental consent required, where they are more likely to be overexposed or sunburned, which is exactly what these doctors say they are trying to avoid.
"The same doctors that are objecting to tanning salons are injecting botulism into people's lips," chortles Overstreet. "Give me a tan any day!"
Only one state - California - bans tanning salons for use by those 18 or younger. Thirty-two other states, including New Jersey but not Pennsylvania, require parental consent for anyone 18 or younger. Brod is trying to change that through Senate Bill 349, which passed the state Senate by a vote of 48-1 on Oct. 31 and passed out of the House health committee early last month.
It calls for banning the use of tanning salons for anyone younger than 14 without a letter from a physician; parental consent for those under 18; the addition of warning signs that exposure to ultraviolet light can be dangerous; appropriate licensing; periodic inspections; and training for those who operate tanning beds. "There is no such thing as a safe tan," Brod says. "A tan is a sign of damaged skin."
"Heaven help the person who comes into my office with an obvious tan," says Lilley, who is taking a fellowship in pediatric endocrinology. "I decided that what happened to me happened for a reason. I was lucky it was caught early." The fact that it did not metastasize and was treated promptly means Lilley is considered cured.
"As a pediatrician, I'm an advocate for children. I know the salons can be addictive. You're alone relaxing and listening to music. Even though you're climbing into this device that looks like a coffin, you feel invincible. But I know what can happen. It happened to me. That's the message I want to give my kids."
Contact Gloria Hochman at firstname.lastname@example.org