J Clin Aesthet Dermatol. 2020;13(7):45–46
by Chelsea T. Schwartz, DO; Harib H. Ezaldein, MD; and Miesha Merati, DO
Dr. Schwartz is with the Department of Internal Medicine at The Christ Hospital in Cincinnati, Ohio. Dr. Ezaldein is with the Department of Dermatology at Case Western/University Hospitals in Cincinnati, Ohio. Dr. Merati is with the The Parker Skin and Aesthetic Clinic in Beachwood, Ohio.
FUNDING: No funding was provided for this study.
DISCLOSURES: The authors have no conflicts of interest relevant to the content of this article.
ABSTRACT: Background. There appears to be limited research on whether the ultraviolet radiation used in nail lamps for gel manicures is increasing the incidence of skin cancer on the hands and nails of young adults.
Objective. We sought to assess evidence in the literature regarding the incidence of skin cancer on the hands and nails of young adults who receive gel manicures cured by ultraviolet light.
Methods. An extensive systematic literature review was conducted, focusing on patients aged 40 years or younger with a history of gel manicures diagnosed with nonmelanoma or melanoma skin cancers on the dorsum of their hands and nails. The Surveillance, Epidemiology and End-results Program (SEER) (SEER 9 and SEER 21) was chosen to analyze trends in the incidence of melanoma from 2007 to 2016. The SEER*Stat Client-serve Mode software was used to retrieve the incidence rates of melanoma of the skin among individuals aged 0 to 39 years from 1975 to 2016.
Results. There have been no cases reported of patients younger than the age of 40 years with a history of chronic gel manicures diagnosed with nonmelanoma skin cancer or melanoma on the dorsum of the hands or nail matrices. SEER revealed little to no change in the incidence of melanoma among patients under the age of 65 years.
Conclusion. The literature is controversial regarding whether ultraviolet radiation from chronic gel manicures increases the risk of skin cancer on the hands and nails. A comprehensive literature search and the SEER database revealed that gel manicures have little to no carcinogenic risk.
Keywords: Gel manicures, ultraviolet light nail lamps, nonmelanoma skin cancer, melanoma, hands, nails
Gel manicures are an ongoing and increasing beauty trend. Ultraviolet (UV) radiation (UVR) has been used for three decades in the nail industry as a crucial step of a gel manicure. Ultraviolet nail lamps or light-emitting diode lamps cure the nail polish to help it dry and harden, usually at wavelengths of 340 to 380nm.1 From 2010 to 2011, more than 87 percent of nail salons reported offering UV nail lamp services, with patrons receiving 1 to 4 services for 6 to 10 minutes during each monthly visit.2 The nail lamps used mainly emit UVA radiation, which is known to play a role in the pathogenesis of skin cancer.1 Some data suggests that melanoma and nonmelanoma (NMSC) skin cancer in young adults is increasing, potentially related to UV exposure.3 The aim of our study was to see whether growing UV exposure from gel manicures is increasing the risk of skin cancer on the dorsum of the hands and nail matrices in young adults.
A literature search in PubMed was performed on April 11, 2019, focusing on reports of melanoma and NMSC located specifically on the dorsum of the hands and nail matrices. Our inclusion criteria were a patient population younger than 40 years old with a history of gel manicures. We excluded patients with a history of skin cancer linked to a genetic mutation and patients older than the age of 40 years. The key words or phrases used for the literature review were young adults, age under forty, dorsum of hands, periungual, subungual, squamous cell carcinoma, basal cell carcinoma, NMSC, melanoma, gel manicures, and UV nail lamps.
The Surveillance, Epidemiology, and End-results Program (SEER) was used to retrieve statistical data on melanoma of the skin. Separately, the SEER*Stat Client-Serve Mode software was chosen to retrieve incidence rates of melanoma of the skin in individuals aged 0 to 39 years from 1975 to 2016. Rates were per 100,000 and age-adjusted to the 2000 United States standard population (19 age groups-Census P25-1130) standard. SEER 9 and SEER 21 were also used to analyze trends in the incidence of melanoma in patients above and below the age of 65 years, respectively, from 2007 to 2016.
Based on our systematic review, no literature has been reported covering patients under the age of 40 years with a history of chronic gel manicures diagnosed with melanoma or NMSC on the dorsum of their hands or nail matrices.
The data from SEER 9 (encompassing Connecticut, Detroit, Atlanta, San Francisco–Oakland, Hawaii, Iowa, New Mexico, Seattle–Puget Sound, and Utah) revealed rates of melanoma have been rising on an average of 1.5 percent each year over the last 10 years. In 2019, an estimated 96,480 new cases of melanoma were expected to present, with a median age of diagnosis of 65 years. No change in the incidence of melanoma can be seen from 2007 to 2016 in patients younger than 65 years old. Data from SEER 21 (encompassing the Alaska Native Tumor Registry, Connecticut, Detroit, Atlanta, greater Georgia, rural Georgia, San Francisco–Oakland, San Jose–Monterey, greater California, Hawaii, Idaho, Iowa, Kentucky, Los Angeles, Louisiana, Massachusetts, New Mexico, New Jersey, New York, Seattle–Puget Sound, and Utah) showed an annual percent increase of incidence among adults above 65 of 2.5 percent but no change among those younger than 65 years from 2007 to 2016. In the age group 15 to 39 years, there was a minimal change in the incidence from 2006 to 2016, from 8.54 (per 100,000) in 2006 to 8.3 (per 100,000) in 2016.4
Overall, our findings suggest that gel manicures do not increase the risk of melanoma and NMSC on the dorsum of the hands and nails of young adults. The only known cases, reported in 2009, were in two women both over the age of 40 years who presented with squamous cell carcinoma on the dorsum of their hands after years of gel manicures.1 The data with SEER reiterate this conclusion further with the minimal change in the incidence of melanoma observed among young adults ages 15 to 39 between the years 2006 and 2016.4 A limitation of our study is that SEER does not provide data on basal or squamous cell carcinoma and does not specify the melanoma location, which is important to consider when determining the risk of chronic UVR exposure from gel manicures. Additionally, the number of NMSCs in young adults might be underreported, especially its potential relationship with UV gel manicures, which might be difficult to determine considering confounding factors.
Two cases, one of a 25-year-old man and another of a 30-year-old woman, were reported in 2012 with subungual melanoma in-situ, but neither had a reported history of gel manicures. Subungual melanomas are rare and trauma is thought to be the leading risk factor rather than UVR. The incidence of invasive subungual melanoma accounts for 0.1 per 100,000 cases per year.5
The current literature on the risk of UV nail lamps causing skin cancer diagnosed in young adults is limited and controversial. A study reported by Stern et al6 used human cadaveric nails and found that the nail plate completely blocks UVB and allows only 0.5% to 2.5% of UVA to penetrate. Eumelanin is responsible for this photo protection, which absorbs, reflects, and scatters UVR. Another study conducted in 2014 by Shipp et al7 calculated the threshold for DNA damage from 17 different nail lamps from 16 salons by evaluating the unweighted UVA and UVB irradiance of a variety of nail polish-drying devices. These authors concluded that the irradiance values were different among the 17 drying devices and not evenly distributed over the exposed hands. Although, multiple visits to the nail salon with a threshold of eight to 208 nail lamp sessions still only impose a low carcinogenetic risk. On the other hand, another study concluded that less than 10 minutes of UVR from nail lamps is equal to the recommended energy dose for an entire day.8 According to a survey conducted by Bollard et al,9 those among the general public appear to believe there is a carcinogenic potential of nail lamps. An online survey was distributed and 424 individuals responded, with 98 percent being women. Overall, 72 percent of respondents believed there was a cancer risk and 82 percent reported they would not continue receiving gel manicures if there was a known risk.
It is known that there is a statistically significant risk between artificial tanning and NMSC, which is attributed to the UV element of tanning. Research focused on UV-emitting tanning devices have classified them as a Group 1 carcinogen. Even though research is lacking on the carcinogenic risk from the UV light emitted during gel manicures, it could be argued that any form of repeated UV radiation exposure could have a carcinogenic potential. To mitigate this potential risk, a UV sun protection cream could be easily replace normal moisturizer in nail salons and could potentially protect patients while awaiting further research.10
To the best of our knowledge, our study, to date, is the only to focus on a population of young adults with a chronic history of gel manicures diagnosed with skin cancer, specifically assessing the hands and nails. Based on our literature review and the SEER database, there is little to no carcinogenic risk inherent with UV gel manicures. Although, the limited literature reported on this topic is controversial and further studies on the potential carcinogenic risk of UV nail lamps are warranted. Therefore, it is recommended by experts to apply a broad-spectrum sunscreen prior to gel manicures.7
- Shihab N, Lim H. Potential cutaneous carcinogenic risk of exposure to UV nail lamp: a review. Photodermatol Photoimmunol Photomed. 2018;34(6):362–365.
- Markova A, Weinstock MA. Risk of skin cancer associated with the use of UV nail lamp. J Invest Dermatol. 2013;133(4):1097–1099.
- Purdue MP, Freeman LE, Anderson WF, Tucker MA. Recent trends in incidence of cutaneous melanoma among US Caucasian young adults. J Invest Dermatol. 2008;128((12)):2905–2908.
- Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Incidence—SEER 9 Regs Research Data, Nov 2018 Sub (1975–2016) <Katrina/Rita Population Adjustment> – Linked To County Attributes – Total U.S., 1969–2017 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, released April 2019, based on the November 2018 submission.
- Rosendahl C, Cameron A, Wilkinson D, et al. Nail matrix melanoma: consecutive cases in a general practice. Dermatol Pract Conc. 2012;2(2):13.
- Stern DK, Creasey AA, Quijije J, Lebwohl MG. UV-A and UV-B penetration of normal human cadaveric finger nail plate. Arch Dermatol. 2011;147:439–441.
- Shipp LR, Warner CA, Rueggeberg FA, Davis LS. Further investigation into the risk of skin cancer associated with the use of UV nail lamps. JAMA Dermatol. 2014;150(7):775–776.
- Curtis J, Tanner P, Judd C, Childs B, Hull C, Leachman S. Acrylic nail curing UV lamps: high-intensity exposure warrants further research of skin cancer risk. J Am Acad Dermatol. 2013;69:1069–1070
- Bollard SM, Beecher SM, Moriarty N, et al. Skin cancer risk and the use of UV nail lamps. Australas J Dermatol. 2018;59(4):348–349.
- Wilson J, and Maraka J. Need for sun cream with your manicure? Dangers of UV nail dryers. J Plast Reconstr Aesthet Surg. 2016;69(6):871.