Skip to main content

Advertisement

SpringerLink
Log in

UV-induced skin cancer at workplace and evidence-based prevention

  • Review
  • Published:
International Archives of Occupational and Environmental Health Aims and scope Submit manuscript

Abstract

Purpose

The present review is aimed at providing an overview of skin cancer with particular focus on occupational concern and giving evidence-based recommendation for effective prevention at workplace.

Methods

We performed a systematic search of literature using PubMed and the Cochrane Library.

Results

Outcome of preventive strategies depends either on efficacy of the strategy itself but also on acceptance and implementation of protective means among the persons at possible risk for hazardous health effects. Epidemiological studies have reported significantly more non-melanoma skin cancer in men than in women. Life-style choices and difference in immunosuppression play a major role in this gender disparity. Tumor biology of skin cancer is diverging: severe blistering sunburns corresponding to intermittent intense UV exposures are associated with an increased risk for both melanoma and basal cell carcinoma (BCC); whereas the risk of squamous cell carcinoma (SCC) and actinic keratoses (AK) is strongly associated with chronic UV exposure. Several clinical trials give evidence that long-term use of sunscreen prevents the appearance of non-melanotic skin cancer such as AK and SCC, but not of BCC. All technical and organizing measures aimed at reducing UV exposure at workplace belong to first-line prevention; however, there is much room for improvement. The efficacy of personal protection means (second-line strategy) strongly depends on the workers’ compliance which is quite low at workplace.

Conclusion

Evidence-based data confirming the benefit of sun protective strategies are scarce, general recommendations are mainly based on the avoidance of UV radiation being identified as potential risk factor for non-melanoma skin cancer in epidemiological studies. Occupational screenings should include regular interventions aimed at enhancing a clear understanding of risk factors for individuals and finally improving the acceptance and maintenance for UV-protective means at workplace.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Allison JJ, Kiefe CI, Weissman NW, Carter J, Centor RM (1999) The art and science of searching medline to answer clinical questions. Finding the right number of articles. Int J Technol Assess Health Care 15:281–296

    CAS  Google Scholar 

  • Araki K, Nagano T, Ueda M, Washio F, Watanabe S, Yamaguche N, Ichihashi M (1999) Incidence of skin cancers and precancerous lesions in Japan: risk factors and prevention. J Epidemiol 1999(9):S14–S21

    Google Scholar 

  • Armstrong B, Kricker A (2001) The epidemiology of UV induced skin cancer. J Photochem Photobiol B 63:8–18

    Article  CAS  Google Scholar 

  • Autier P, Doré JF, Negrier S, Lienard D, Panizzon R, Lejeune FJ, Guggisberg D, Eggermont AMM (1999) Sunscreen use and duration of sun exposure: a double-blind, randomized trial. J Natl Cancer Inst 91:1304–1309

    Article  CAS  Google Scholar 

  • Azizi E, Flint P, Sadetzki S, Solomon A, Lerman Y, Harari G, Pavlotsky F, Kushelevsky A, Glesinger G, Shani E, Rosenberg L (2000) A graded work site intervention program to improve sun protection and skin cancer awareness in outdoor workers in Israel. Cancer Causes Control 11:513–521

    Article  CAS  Google Scholar 

  • Bajdik CD, Gallagher RP, Astrakianakis G et al (1996) Non-solar ultraviolet radiation during welding and the risk of basal and squamous cell skin cancer. Br J Cancer 1996(73):1612–1614

    Google Scholar 

  • Bastuji-Garin S, Diepgen TL (2002) Cutaneous malignant melanoma, sun exposure, and sunscreen use: epidemiological evidence. Br J Dermatol 146(Suppl. 61):24–30

    Article  Google Scholar 

  • Bath-Hextall FJ, Leonardi-Bee J, Somchand N, Webster AC, Delitt J, Perkins W (2009) Interventions for preventing non-melanoma skin cancers in high-risk groups. The Cochrane Collaboration issue 2. http://www.thechochranelibrary.com

  • Bauer J, Büttner P, Wiecker TS, Luther H, Garbe C (2005) Effect of sunscreen and clothing on the number of melanocytic nevi in 1812 German children attending day care. Am J Epidemiol 161:620–627

    Article  Google Scholar 

  • Beani JC (1996) Le danger des photoprotecteurs externs. Le Concours Med 29(6):1804–1808

    Google Scholar 

  • Berking C (2005) The role of ultraviolet irradiation in malignant melanoma. Hautarzt 56:687–697

    Article  CAS  Google Scholar 

  • Bordea C, Wojnarowski F, Millard PR, Doll H, Welsh K, Morris PJ (2004) Skin cancers in renal transplant patients occur more frequently than previously recognised in a temperate climate. Transplantation 77:574–579

    Article  CAS  Google Scholar 

  • Bränström R, Kristjansson S, Ullén H (2006) Risk perception, optimistic bias, and readiness to change sun related behaviour. Eur J Public Health 16:492–497

    Google Scholar 

  • Cole CA (2001) Sunscreen protection in the ultraviolet A region: how to measure the effectiveness. Photodermatol Photoimmunol Photomed 17:2–10

    Article  CAS  Google Scholar 

  • Cole CA, Forbes PD, Davies RE (1986) An action spectrum for UV photocarcinogenesis. Photochem Photobiol 43:275–284

    Article  CAS  Google Scholar 

  • Currie CLA, Monk B (2000) Welding and non-melanoma skin cancer. Clin and Experim Dermatol 25:28–29

    Article  CAS  Google Scholar 

  • Damian DL, Patterson CRS, Stapelberg M, Park J, Barnetson RStC, Halliday GM (2008) UV radiation-induced immunosuppression is greater in men and prevented by topical nicotinamide. J Invest Dermatol 128:447–454

    CAS  Google Scholar 

  • Darlington S, Williams G, Neale R, Frost C, Green A (2003) A randomized controlled trial to assess sunscreen application and beta carotene supplementation in the prevention of solar keratosis. Arch Dermatol 139:451–455

    Article  Google Scholar 

  • Darvay A, White IR, Rycroft RJ, Jones AB, Hawk JL, McFadden (2001) Photoallergic contact dermatitis is uncommon. Br J Dermatol 145 84:597–601

    Article  Google Scholar 

  • Debuys HV, Levy SB, Murray JC, Madey DL, Pinnell SR (2000) Modern approaches to photoprotection: dermatologic aspects. Cosmetics 18:577–590

    CAS  Google Scholar 

  • Diffey BL (1991) Solar ultraviolet radiation effects on biological systems. Phys Med Biol 36:299–328

    Article  CAS  Google Scholar 

  • Dixon AJ, Dixon BF (2004) Ultraviolet radiation from welding and possible risk of skin and ocular malignancy. Med J Aust 181:155–157

    Google Scholar 

  • Dogan G (2007) Basal cell carcinoma in outdoor versus indoors workers in Turkey. Int J Dermatol 46:43–46

    Article  Google Scholar 

  • Elsner P, Hölzle E, Diepgen T, Grether-Beck S, Hönigsmann H, Krutmann J, Scharfetter-Kochanek K, Schwarz T, Luger T (2007) Recommendation: daily sun protection in the prevention of chronic UV-induced skin damage. JDDG 2. Band 5:0166–0502

    Google Scholar 

  • Emmett EA, Buncher CR, Suskind RB, Rowe KW Jr (1981) Skin cancer and eye disease among arc welders those exposed to welding operations. J Occup Med 23:85–90

    Article  CAS  Google Scholar 

  • Faurschou A, Wulf HC (2007) The relation between sun protection factor and amount applied in vivo. Br J Dermatol 156:716–719

    Article  CAS  Google Scholar 

  • Foote JA, Harris RB, Guiliano AR, Roe TE, Moon B, Cartmel B, Alberts DS (2001) Predictors for cutaneous basal and squamous cell carcinoma among actinically damaged adults. Int J Cancer 95:7–11

    Article  CAS  Google Scholar 

  • Freedman DM, Zahm SH, Dosemeci M (1997) Residential and occupational exposure to sunlight and mortality from non-Hodgkin’s lymphoma: composite (threefold) case-control study. BMJ 314:1451–1455

    CAS  Google Scholar 

  • Gallagher RP, Ma B, McLean DI, Yang CP, Ho V, Carruthers JA, Warshawski LM (1990) Trends in basal cell carcinoma, squamous cell carcinoma, and melanoma of the skin from 1973 trough 1987. J Am Acad Dermatol 23:413–421

    Article  CAS  Google Scholar 

  • Gallagher RP, Rivers JK, Lee TK, Badjik CD, McLeanm DI, Goldman AJ (2000) Broad-spectrum sunscreen use and the development of new nevi in white children: a randomized controlled trial. JAMA 283:2955–2960

    Article  CAS  Google Scholar 

  • Gambichler T, Hatch KL, Avermaete A, Altmeyer P, Hoffmann K (2002) Influence of wetness on the ultraviolet protection factor of textiles: in vitro and in vivo measurements. Photodermatol Photoimmunol Photomed 18:29–35

    Article  Google Scholar 

  • Gandini S, Sera F, Cattaruza MS et al (2005) Meta-analysis of risk factors for cutaneous melanoma: II. Sun exposure. Eur J Cancer 41:45–60. doi:10.1016/j.ejca.2004.10.016

    Article  Google Scholar 

  • Garbe C, Blum A (2001) Epidemiology of cutaneous melanoma in Germany and worldwide. Skin Pharmacol Apll Skin Physiol 14:280–290

    Article  CAS  Google Scholar 

  • Glanz K, Buller DB, Soraiya M (2007) Reducing ultraviolet radiation exposure among outdoor workers: state of the evidence and recommendations. Environ Health 6: 22. doi: 10.1186/1476-069X-6-22

  • Glanz K, Yaroch AL, Dancel M, Saraiya M, Crane LA, Buller DB, Manne S, O’Riordan DL, Heckman CJ, Hay J, Robinson JK (2008) Measures of sun exposure and sun protection practices for behavioural and epidemiologic research. Arch Dermatol 144:217–222

    Article  Google Scholar 

  • González S, Fernández-Lorente M, Gilaberte-Calzada (2008) The latest on skin photoprotection. Clinics in Dermatol 26:614–626

    Article  Google Scholar 

  • Graells J (2004) The risk and risk factors of a second non-melanoma skin cancer: a study in the Mediterranean population. J Eur Acad Dermatol 18:142–147

    Article  CAS  Google Scholar 

  • Gray D, Suman V, SU W, Clay R, Roenigk R (1997) Trends in the population-based incidence of squamous cell carcinoma of the skin first diagnosed between 1984 and 1992. Arch Dermatol 133:735–740

    Article  CAS  Google Scholar 

  • Green A, Williams W, Neale R, Hart V, Leslie D, Parson P, Marks GC, Gaffney P, Battistutta D, Frost C, Lang C, Russell A (1999) Daily sunscreen application and betacarotene supplementation in prevention of basal-cell and squamous-cell-carcinomas of the skin: a randomised controlled trial. Lancet 354:723–729

    Article  CAS  Google Scholar 

  • Hall DM, McCarty F, Elliott T, Glanz K (2009) Lifeguards’ sun protection habits and sunburns: association with sun-safe environments and skin cancer prevention program participation. Arch Dermatol 145:139–144

    Article  Google Scholar 

  • Hammond V, Reeder AI, Gray A (2009) Patterns of real-time occupational ultraviolet radiation exposure among a sample of outdoor workers in New Zealand. Public Health 123:182–187

    Article  CAS  Google Scholar 

  • Hensen P, Müller ML, Haschemi R, Ständer H, Luger TA, Sunderkötter C, Schiller M (2009) Predesposing factors of actinic keratosis in a North-West German Population. Eur J Dermatol 19:345–354

    Google Scholar 

  • Huncharek M, Kupelnick B (2002) Use of topical sunscreens and the risk of malignant melanoma: a meta-analysis of 9067 patients from 11 case–control studies. Am J Public Health 92:1173–1177

    Article  Google Scholar 

  • Karagas M, Greenberg RE, Spencer SK, Stukel TA, Mott LA (1999) Increase in the incidence rates of basal cell carcinoma and squamous cell carcinoma in New Hampshire, USA. Int J Cancer 81:555–559

    Article  CAS  Google Scholar 

  • Kauppinen T, Toikkanen J, Pedersen D, Young R, Ahrens W, Boffetta P, Hansen J, Kromhour H, Blasquo JM, Mirabelli D, de la Ordn-Rivera V et al (2000) Occupational exposure to carcinogens in the European Union. Occup Environ Med 57:10–18

    Article  CAS  Google Scholar 

  • Kim KH, Young JI (1992) Influence of ultraviolet A on scheduled and unscheduled DNA synthesis by ultraviolet B. Photoderm Photoimmunol Photomed 9:36–39

    CAS  Google Scholar 

  • Kütting B, Drexler H (2007) Evaluation of skin protective means against acute and chronic effects of UV-radiation from sunlight. In: Schliemann S, Elsner P (eds) Skin Protection . Curr Probl Dermatol. Basel, Karger, vol 34, pp 87–97

  • Kütting B, Weistenhöfer W, Baumeister T, Uter W, Drexler H (2009) Current acceptance and implementation of preventive strategies for occupational hand eczema in 1355 metal workers in Germany. Br J Dermatol 161:390–396

    Article  Google Scholar 

  • Lear JT, Tran BB, Smith AG, Bowrs W, Jones PW, Heagerty AH, Strange RC, Fryer AA (1997) Risk factors for basal cell carcinoma in the UK: a case-control study in 806 patients. J R Soc Med 90:371–374

    CAS  Google Scholar 

  • Lewis EC, Mayer JA, Slymen D (2006) Postal workers’ occupational and leisure-time sun safety behaviours (United States). Cancer Causes Control 17:181–186

    Article  Google Scholar 

  • Lichte V, Dennenmoser B, Dietz K, Häfner HM, Schlagenhauff B, Garbe C, Fischer J, Moehrle M (2009) Professional risk for skin cancer development in male mountain guides—a cross-sectional study. JEADV. doi:10.1111/j.1468-3083.2009.03528.x

  • Mang R, Krutmann J (2003) Sun protection during holidays. Hautarzt 54:498–505

    Article  CAS  Google Scholar 

  • Marehbian J, Colt JS, Baris D, Stewart P, Stukel TA, Spencer SK, Karagas MR (2007) Occupation and kerationocyte cancer risk: a population-based case-control study. Cancer Causes Control 18:895–908

    Article  Google Scholar 

  • Marks R (1999) Photoprotection and prevention of melanoma. Eur J Dermatol 9(5):406–412

    CAS  Google Scholar 

  • Marks R, Folley PA, Jolly D, Knight KR, Harrison J, Thompson SC (1995) The effect of regular sunscreen use on Vitamin D levels in an Australian population. Results of a randomized controlled trial. Arch Dermatol 131:415–421

    Article  CAS  Google Scholar 

  • McCool JP, Reeder AI, Robinson EM, Petrie KJ, Gorman DF (2009) Outdoor workers’ perception of the risks of excess sun-exposure. J Occup Health 51:404–411

    Article  Google Scholar 

  • Naylor MF, Boyd A, Smith DW, Cameron GS, Hubbard D, Neldner KH (1995) High sun protection factor sunscreens in the suppression of actinic neoplasia. Arch Dermatol 131:170–175

    Article  CAS  Google Scholar 

  • Nohynek GJ, Schaefer H (2001) Benefit and risk of organic ultraviolet filters. Regul Toxicol Pharmacol 33:285–299

    Article  CAS  Google Scholar 

  • Oberyszyn TM (2008) Non-melanoma skin cancer: importance of gender, immunosuppressive status and vitamin D. Cancer Lett 261:127–136

    CAS  Google Scholar 

  • Parrott R, Steiner C, Goldenhaar L (1996) Georgia’s harvesting healthy habits: a formative evaluation. J Rural Health 12:291–300

    Article  CAS  Google Scholar 

  • Radespiel-Tröger M, Meyer M, Pfahlberg A, Lausen B, Uter W, Gefeller O (2009) Outdoor work and skin cancer incidence: a registry-based study in Bavaria. Int Arch Occup Environ Health 82:357–363

    Article  Google Scholar 

  • Rigel DS (2002) Photoprotection: a 21st century perspective. Br J Dermatol 146(Suppl. 61):34–37

    Article  Google Scholar 

  • Roseman KD, Gardiner J, Swanson GM, Mullan P, Zhu Z (1995) Use of skin-cancer prevention strategies among farmers and their spouses. Am J Prev Med 11:342–347

    Google Scholar 

  • Rosen CF (2003) Topical and systemic photoprotection. Dermatol Ther 16:8–15

    Article  Google Scholar 

  • Rosenberg W, Donald A (1995) Evidence-based medicine: an approach to clinical problem-solving. BMJ 310:1122–1126

    CAS  Google Scholar 

  • Rosso S, Zanetti R, Martinez C, Tormo MJ, Schraub S, Sancho-Garnier H, Franceschi S, Gafà L, Perea E, Navarro C, Laurent R, Schrameck C, Talamini R, Tumino R, Wechsler J (1996) The multicentre south European study “Helios” II: different sun exposure patterns in the etiology of basal cell and squamous cell carcinomas of the skin. Br J Cancer 73:1447–1454

    CAS  Google Scholar 

  • Sackett DL, Straus SE, Richardson WS et al. (2000) Evidence-based medicine. How to practice and teach, 2nd edn. Churchill Livingstone, London

  • Saladi RN, Persaud AN (2005) The causes of skin cancer: a comprehensive review. Drugs Today 41:37–53

    Article  CAS  Google Scholar 

  • Salas R, Mayr JA, Hoerster KD (2005) Sun-protective behaviours of California Farmworkers. J Occup Environ Med 47:1244–1249

    Article  Google Scholar 

  • Saraiya M, Glanz K, Briss P, Nichols P, White C, Das D, Smith SJ, Tannor B, Hutchinson AB, Wilson KM, Gandhi N, Lee NC, Rimer B, Coates RC, Kerner JF, Hiat RA, Buffler P, Rochester P (2004) Interventions to prevent skin cancer by reducing exposure to ultraviolet radiation. A systematic review. Am J Prev Med 27(5):422–466

    Google Scholar 

  • Scheuer E, Warshaw E (2006) Sunscreen allergy: a review of epidemiology, clinical characteristics, and responsible allergens. Dermatitis 17:3–11

    Google Scholar 

  • Scrivener Y, Grosshans E, Cribier B (2002) Variations of basal cell carcinomas according to gender, age, location and histopathological subtype. Br J Dermatol 147:41–47

    Article  CAS  Google Scholar 

  • Stepanski BM, Mayer JA (1998) Solar protection behaviours among outdoor workers. J Occup Envir Med 40:43–48

    Article  CAS  Google Scholar 

  • Talve L, Stenback F, Jansen CT (1990) UVA irradiation increases the incidence of epithelial tumors in UVB-irradiated hairless mice. Photodermatol Photoimmunol Photomed 7:109–115

    CAS  Google Scholar 

  • Thompson SC, Jolley D, Marks R (1993) Reduction of solar keratoses by regular sunscreen use. N Engl J Med 329:1147–1151

    Article  CAS  Google Scholar 

  • Ting WW, Vest CD, Sontheimer R (2003) Practical and experimental consideration of sun protection in dermatology. Int J Dermatol 42:505–513

    Article  Google Scholar 

  • Vishvakarman D, Wong JCF (2003) Description of the use of a risk estimation model to assess the increased risk of non-melanoma skin cancer among outdoor workers in Central Queensland, Australia. Photodermatol Photoimmunol Photomed 2003(19):81–88

    Google Scholar 

  • Walther UW, Kron M, Sander S, Sebastian G, Sander R, Peter RU, Meurer M, Krähn G (2004) Kaskel P (2004) Risk and protective factors for sporadic basal cell carcinoma: results of a two-centre case control study in southern Germany. Clinical actinic elastosis may be a protective factor. Br J Dermatol 151:170–178

    Article  CAS  Google Scholar 

  • Woolley T, Buettner P, Lowe J (2002) Sun-related behaviours of outdoor working men with a history of non-melanoma skin cancer. J Occup Environ Med 44:847–854

    Article  Google Scholar 

  • Young RW (1994) The family of sun-light related eye disease. Optom Vis Sci 71:125–144

    Article  CAS  Google Scholar 

Download references

Conflict of interest statement

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, University of Erlangen- Nuremberg, Schillerstr. 25 + 29, 91054, Erlangen, Germany

    Birgitta Kütting & Hans Drexler

Authors
  1. Birgitta Kütting
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hans Drexler
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Birgitta Kütting.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kütting, B., Drexler, H. UV-induced skin cancer at workplace and evidence-based prevention. Int Arch Occup Environ Health 83, 843–854 (2010). https://doi.org/10.1007/s00420-010-0532-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00420-010-0532-4

Keywords

Search

Navigation