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

Review

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.

Keywords

Skin cancer Occupational exposure to UV radiation Evidence-based prevention Risk factors Sunscreen UV protection 

References

  1. 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
  2. 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
  3. Armstrong B, Kricker A (2001) The epidemiology of UV induced skin cancer. J Photochem Photobiol B 63:8–18CrossRefGoogle Scholar
  4. 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 91:1304–1309CrossRefGoogle Scholar
  5. 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
  6. 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
  7. Bastuji-Garin S, Diepgen TL (2002) Cutaneous malignant melanoma, sun exposure, and sunscreen use: epidemiological evidence. Br J Dermatol 146(Suppl. 61):24–30CrossRefGoogle Scholar
  8. 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
  9. 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 161:620–627CrossRefGoogle Scholar
  10. Beani JC (1996) Le danger des photoprotecteurs externs. Le Concours Med 29(6):1804–1808Google Scholar
  11. Berking C (2005) The role of ultraviolet irradiation in malignant melanoma. Hautarzt 56:687–697CrossRefGoogle Scholar
  12. 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 77:574–579CrossRefGoogle Scholar
  13. 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
  14. Cole CA (2001) Sunscreen protection in the ultraviolet A region: how to measure the effectiveness. Photodermatol Photoimmunol Photomed 17:2–10CrossRefGoogle Scholar
  15. Cole CA, Forbes PD, Davies RE (1986) An action spectrum for UV photocarcinogenesis. Photochem Photobiol 43:275–284CrossRefGoogle Scholar
  16. Currie CLA, Monk B (2000) Welding and non-melanoma skin cancer. Clin and Experim Dermatol 25:28–29CrossRefGoogle Scholar
  17. 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
  18. 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 139:451–455CrossRefGoogle Scholar
  19. Darvay A, White IR, Rycroft RJ, Jones AB, Hawk JL, McFadden (2001) Photoallergic contact dermatitis is uncommon. Br J Dermatol 145 84:597–601CrossRefGoogle Scholar
  20. Debuys HV, Levy SB, Murray JC, Madey DL, Pinnell SR (2000) Modern approaches to photoprotection: dermatologic aspects. Cosmetics 18:577–590Google Scholar
  21. Diffey BL (1991) Solar ultraviolet radiation effects on biological systems. Phys Med Biol 36:299–328CrossRefGoogle Scholar
  22. Dixon AJ, Dixon BF (2004) Ultraviolet radiation from welding and possible risk of skin and ocular malignancy. Med J Aust 181:155–157Google Scholar
  23. Dogan G (2007) Basal cell carcinoma in outdoor versus indoors workers in Turkey. Int J Dermatol 46:43–46CrossRefGoogle Scholar
  24. 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
  25. 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 23:85–90CrossRefGoogle Scholar
  26. Faurschou A, Wulf HC (2007) The relation between sun protection factor and amount applied in vivo. Br J Dermatol 156:716–719CrossRefGoogle Scholar
  27. 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 95:7–11CrossRefGoogle Scholar
  28. 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
  29. 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 23:413–421CrossRefGoogle Scholar
  30. 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 283:2955–2960CrossRefGoogle Scholar
  31. 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 18:29–35CrossRefGoogle Scholar
  32. 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 CrossRefGoogle Scholar
  33. Garbe C, Blum A (2001) Epidemiology of cutaneous melanoma in Germany and worldwide. Skin Pharmacol Apll Skin Physiol 14:280–290CrossRefGoogle Scholar
  34. 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
  35. 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 144:217–222CrossRefGoogle Scholar
  36. González S, Fernández-Lorente M, Gilaberte-Calzada (2008) The latest on skin photoprotection. Clinics in Dermatol 26:614–626CrossRefGoogle Scholar
  37. 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 18:142–147CrossRefGoogle Scholar
  38. 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 133:735–740CrossRefGoogle Scholar
  39. 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
  40. 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 145:139–144CrossRefGoogle Scholar
  41. 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 123:182–187CrossRefGoogle Scholar
  42. 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
  43. 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 92:1173–1177CrossRefGoogle Scholar
  44. 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 81:555–559CrossRefGoogle Scholar
  45. 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 57:10–18CrossRefGoogle Scholar
  46. 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
  47. 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
  48. 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 161:390–396CrossRefGoogle Scholar
  49. 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
  50. Lewis EC, Mayer JA, Slymen D (2006) Postal workers’ occupational and leisure-time sun safety behaviours (United States). Cancer Causes Control 17:181–186CrossRefGoogle Scholar
  51. 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
  52. Mang R, Krutmann J (2003) Sun protection during holidays. Hautarzt 54:498–505CrossRefGoogle Scholar
  53. 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 18:895–908CrossRefGoogle Scholar
  54. Marks R (1999) Photoprotection and prevention of melanoma. Eur J Dermatol 9(5):406–412Google Scholar
  55. 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 131:415–421CrossRefGoogle Scholar
  56. McCool JP, Reeder AI, Robinson EM, Petrie KJ, Gorman DF (2009) Outdoor workers’ perception of the risks of excess sun-exposure. J Occup Health 51:404–411CrossRefGoogle Scholar
  57. 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 131:170–175CrossRefGoogle Scholar
  58. Nohynek GJ, Schaefer H (2001) Benefit and risk of organic ultraviolet filters. Regul Toxicol Pharmacol 33:285–299CrossRefGoogle Scholar
  59. Oberyszyn TM (2008) Non-melanoma skin cancer: importance of gender, immunosuppressive status and vitamin D. Cancer Lett 261:127–136Google Scholar
  60. Parrott R, Steiner C, Goldenhaar L (1996) Georgia’s harvesting healthy habits: a formative evaluation. J Rural Health 12:291–300CrossRefGoogle Scholar
  61. 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 82:357–363CrossRefGoogle Scholar
  62. Rigel DS (2002) Photoprotection: a 21st century perspective. Br J Dermatol 146(Suppl. 61):34–37CrossRefGoogle Scholar
  63. 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
  64. Rosen CF (2003) Topical and systemic photoprotection. Dermatol Ther 16:8–15CrossRefGoogle Scholar
  65. Rosenberg W, Donald A (1995) Evidence-based medicine: an approach to clinical problem-solving. BMJ 310:1122–1126Google Scholar
  66. 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
  67. Sackett DL, Straus SE, Richardson WS et al. (2000) Evidence-based medicine. How to practice and teach, 2nd edn. Churchill Livingstone, LondonGoogle Scholar
  68. Saladi RN, Persaud AN (2005) The causes of skin cancer: a comprehensive review. Drugs Today 41:37–53CrossRefGoogle Scholar
  69. Salas R, Mayr JA, Hoerster KD (2005) Sun-protective behaviours of California Farmworkers. J Occup Environ Med 47:1244–1249CrossRefGoogle Scholar
  70. 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
  71. Scheuer E, Warshaw E (2006) Sunscreen allergy: a review of epidemiology, clinical characteristics, and responsible allergens. Dermatitis 17:3–11Google Scholar
  72. Scrivener Y, Grosshans E, Cribier B (2002) Variations of basal cell carcinomas according to gender, age, location and histopathological subtype. Br J Dermatol 147:41–47CrossRefGoogle Scholar
  73. Stepanski BM, Mayer JA (1998) Solar protection behaviours among outdoor workers. J Occup Envir Med 40:43–48CrossRefGoogle Scholar
  74. 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
  75. Thompson SC, Jolley D, Marks R (1993) Reduction of solar keratoses by regular sunscreen use. N Engl J Med 329:1147–1151CrossRefGoogle Scholar
  76. Ting WW, Vest CD, Sontheimer R (2003) Practical and experimental consideration of sun protection in dermatology. Int J Dermatol 42:505–513CrossRefGoogle Scholar
  77. 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
  78. 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
  79. 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 44:847–854CrossRefGoogle Scholar
  80. Young RW (1994) The family of sun-light related eye disease. Optom Vis Sci 71:125–144CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  1. 1.Institute and Outpatient Clinic of Occupational, Social and Environmental MedicineUniversity of Erlangen- NurembergErlangenGermany

Personalised recommendations