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At the end of the school year, teenage girls often head to the tanning salon, hoping to look fit and glowing in their prom dresses. But evidence is mounting that too much indoor tanning increases the risk of skin cancer.

As NPR's Patti Neighmond reports, the Food and Drug Administration is taking steps to make sure that teens take the risk seriously.

PATTI NEIGHMOND: It was right before the prom eight years ago. Seventeen-year-old Brittany Cicala was really excited. She was going with the boy she would eventually marry and her dress - well, it was beautiful: delicately beaded lace and spaghetti straps, an elegant A-line in white.

Ms. BRITTANY CICALA: Everyone around me was telling me, man, you would look so much better with a tan and your teeth would look whiter, your acne would go away.

NEIGHMOND: So pale-skinned Brittany did what lots of her friends did; she did what a lot of teens in the U.S. do. She went to a tanning salon. In fact, she went to the salon five, six, often seven days a week, and lay in the tanning bed for 20 to 25 minutes each time.

Ms. CICALA: I called myself a tanorexic, because I would look into the mirror and never see myself as dark as other people would see me - much as an anorexic would never see themselves as thin as other people would see them. So I kept going.

NEIGHMOND: Tanorexic? Yes. That's what a study from psychologist Catherine Mosher, of Memorial Sloan-Kettering Cancer Center, recently confirmed. Mosher analyzed data from more than 420 college students, and had them answer questions typically used to screen for alcohol and substance abuse but modified to ask about tanning habits.

Dr. CATHERINE MOSHER (Behavioral Scientist, Memorial Sloan-Kettering Cancer Center): Do you try to cut down on the time you spend in tanning beds or booths but find yourself still tanning? Do you feel - ever feel guilty that you're using tanning beds or booths too much?

NEIGHMOND: Mosher found the majority of kids answered yes to one or more of these questions, which target addictive behavior. After three years of routine indoor tanning, Brittany Cicala ended up with a serious health problem.

Ms. CICALA: My mom noticed a mole on my back - about the size of a nickel -the summer of 2004. She kept bugging me about it: Brittany, that doesn't look right. You really should go get that checked out.

NEIGHMOND: But Brittany stalled and kept tanning. Then the mole started to bleed. Her doctor took one look at the mole, and scheduled a biopsy for the next morning. Brittany had melanoma, the most aggressive form of skin cancer. Two weeks later, she had surgery to remove the mole, which left a seven-inch scar. Since then, Brittany's had 34 surgeries to remove suspicious moles.

Robin Hornung is a pediatric dermatologist in Washington state. She says rates of melanoma are growing fastest among younger women, 15 to 29 years old, and researchers want to understand why.

Dr. ROBIN HORNUNG (Pediatric Dermatologist, The Everett Clinic): The question is, why is that happening? But a lot of folks would point to, perhaps indoor tanning. That's the group that makes up most of the most indoor tanners, are the young women.

NEIGHMOND: Federal officials say as many as one in five teenagers, mostly girls, have used a tanning bed over the past year. And while teens may think of a tan as a healthy glow, Hornung says it's the body's reaction to injury.

Dr. HORNUNG: We know that a tan is really your skin's response to ultraviolet light damage. DNA breaks; there are mutations in the DNA. And when you get breaking of the DNA, you actually have - a tan is, you know, kind of a healing response.

NEIGHMOND: A recent study found melanoma risk increased as much as three times if people tanned indoors more than 50 hours in their lifetime, or had more than 100 sessions in a tanning booth.

The World Health Organization recently classified tanning beds as carcinogenic, and recommended children under 18 be banned from using them. A number of countries have already put such bans in place. And the Food and Drug Administration, which regulates the tanning industry in the U.S., says it's also considering a ban.

FDA official Sharon Miller says the agency definitely plans to strengthen warning labels on the beds themselves.

Ms. SHARON MILLER (UV Radiation Specialist, FDA): We're planning to use a bulleted format and just be more direct and say that UV can cause skin cancer. You know, not draw it out and make it seem like only people who really abuse it are going to get skin cancer, because we think any exposure does contribute to your risk of skin cancer.

NEIGHMOND: The FDA may also require parents to approve tanning for kids under 18.

John Overstreet, with the Indoor Tanning Association, says bans are intrusive and represent over-regulation.

Mr. JOHN OVERSTREET (Executive Director, Indoor Tanning Association): I think the industry is a great deal more professional than it was 25 years ago. So there's a lot of information available to these businesses that allow them to advise people about how long they should be in the tanning bed without getting overexposed.

NEIGHMOND: Meanwhile, since her own illness, cancer survivor Brittany Cicala has made skin cancer awareness her personal mission. She's testified about tanning and cancer risk at FDA hearings and at medical conferences. But by far, the most important work she does, says Cicala, is at local high schools, where she tells young girls her story about indoor tanning and cancer.

Patti Neighmond, NPR News.

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