UV-induced skin cancer at workplace and evidence-based prevention
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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.
We performed a systematic search of literature using PubMed and the Cochrane Library.
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.
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.
KeywordsSkin cancer Occupational exposure to UV radiation Evidence-based prevention Risk factors Sunscreen UV protection
Conflict of interest statement
The authors declare that they have no conflict of interest.
- 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 15:281–296Google 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–S21Google 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 11:513–521CrossRefGoogle 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):1612–1614Google 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
- Beani JC (1996) Le danger des photoprotecteurs externs. Le Concours Med 29(6):1804–1808Google Scholar
- Bränström R, Kristjansson S, Ullén H (2006) Risk perception, optimistic bias, and readiness to change sun related behaviour. Eur J Public Health 16:492–497Google 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 128:447–454Google Scholar
- Debuys HV, Levy SB, Murray JC, Madey DL, Pinnell SR (2000) Modern approaches to photoprotection: dermatologic aspects. Cosmetics 18:577–590Google Scholar
- Dixon AJ, Dixon BF (2004) Ultraviolet radiation from welding and possible risk of skin and ocular malignancy. Med J Aust 181:155–157Google 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 5:0166–0502Google 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 314:1451–1455Google 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
- 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 354:723–729CrossRefGoogle 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 19:345–354Google Scholar
- Kim KH, Young JI (1992) Influence of ultraviolet A on scheduled and unscheduled DNA synthesis by ultraviolet B. Photoderm Photoimmunol Photomed 9:36–39Google 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 87–97Google 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 90:371–374Google 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
- Marks R (1999) Photoprotection and prevention of melanoma. Eur J Dermatol 9(5):406–412Google Scholar
- Oberyszyn TM (2008) Non-melanoma skin cancer: importance of gender, immunosuppressive status and vitamin D. Cancer Lett 261:127–136Google 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 11:342–347Google Scholar
- Rosenberg W, Donald A (1995) Evidence-based medicine: an approach to clinical problem-solving. BMJ 310:1122–1126Google 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 73:1447–1454Google Scholar
- Sackett DL, Straus SE, Richardson WS et al. (2000) Evidence-based medicine. How to practice and teach, 2nd edn. Churchill Livingstone, LondonGoogle 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):422–466Google Scholar
- Scheuer E, Warshaw E (2006) Sunscreen allergy: a review of epidemiology, clinical characteristics, and responsible allergens. Dermatitis 17:3–11Google Scholar
- Talve L, Stenback F, Jansen CT (1990) UVA irradiation increases the incidence of epithelial tumors in UVB-irradiated hairless mice. Photodermatol Photoimmunol Photomed 7:109–115Google 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):81–88Google 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 151:170–178CrossRefGoogle Scholar