In the eight months since Pennsylvania's indoor tanning law took effect, the state health department has sent letters informing nearly 2,800 facilities that they must register, pay annual fees, and comply with new rules designed to protect consumers, especially teens.
So far, only 133 facilities, less than 5 percent, have signed up.
That may not be surprising, since the state won't start annual inspections and enforcement until next year. But two medical groups that lobbied for the law are calling attention to the apparent recalcitrance.
The Pennsylvania Academy of Dermatology "is encouraging all tanning facilities to register," it said in a recent news release issued with the Pennsylvania Medical Society. "This ensures they are meeting basic safety requirements and educating clients about the risks involved with tanning."
Across the country, dermatologists have led the push for restrictions on indoor tanning by minors, a practice now recognized as hazardous.
In 2009, a World Health Organization research group declared ultraviolet-light-emitting tanning-bed use a risk factor for all forms of skin cancer, including melanomas of the skin and eyes. The group concluded that sun beds increase melanoma risk by 75 percent in people younger than 30.
Almost a quarter of high school girls use indoor tanning beds, according to the U.S. Centers for Disease Control and Prevention.
Pennsylvania, which is among 41 states with indoor tanning laws, requires parental consent for 17-year-olds, and bans anyone younger than 17. (In 2013, the same restrictions were added in New Jersey, where 526 tanning salons are registered.)
Also, tanning salons must annually pay $150 for two sun beds, $300 a year for more than two beds, and $20 per bed over 10 beds. They have to post warning signs, provide protective eyewear, have customers sign a warning statement, and keep records tallying customers' tanning visits.
Although market analysts estimate indoor tanning is a $5 billion business in the United States, the industry has been squeezed by the tougher laws, plus the 10 percent federal tax imposed on salons beginning in 2010.
"I've seen a lot of salons closing up," said Craig D'Amico, who owns Tropic Tanning in Philadelphia, Doylestown, and New Hope. "They always say it's a billion-dollar industry. But it's making less and less."
D'Amico is not a fan of Pennsylvania's new law.
"To me, it's moderation in everything; I like Twinkies, but I don't eat a box a week," he said. "Anything's going to kill you" if overdone.
The law covers not only tanning salons, but also businesses that provide tanning beds as an amenity, including beauty salons, gyms, and apartment complexes.
Before the law passed, state officials guessed Pennsylvania had about 1,500 such facilities. After researching state records, the Department of Health found nearly 2,800 - and sent them letters.
"The mailing list was compiled from information that was provided from the Departments of Labor and Industry, and Revenue," health department spokeswoman Holli Senior said. "We also sent a similar letter to all chambers of commerce, and multiple tanning training providers."
Inspections will begin in May 2016. The department can suspend or revoke the registration of a noncompliant facility, or force an unregistered one to stop operating.