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International Archives of Occupational and Environmental Health

Published in:

01-12-2010 | Review

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

Authors: Birgitta Kütting, Hans Drexler

Published in: International Archives of Occupational and Environmental Health | Issue 8/2010

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.

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

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

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

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 91:1304–1309CrossRef

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 11:513–521CrossRef

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

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

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 161:620–627CrossRef

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

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

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 77:574–579CrossRef

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

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

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

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

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

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 139:451–455CrossRef

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

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

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

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

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

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

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 23:85–90CrossRef

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

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 95:7–11CrossRef

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

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 23:413–421CrossRef

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 283:2955–2960CrossRef

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 18:29–35CrossRef

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 CrossRef

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

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 144:217–222CrossRef

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

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 18:142–147CrossRef

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 133:735–740CrossRef

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 354:723–729CrossRef

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 145:139–144CrossRef

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 123:182–187CrossRef

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

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 92:1173–1177CrossRef

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 81:555–559CrossRef

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 57:10–18CrossRef

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

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 161:390–396CrossRef

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

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

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 54:498–505CrossRef

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 18:895–908CrossRef

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

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 131:415–421CrossRef

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

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 131:170–175CrossRef

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

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

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

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 82:357–363CrossRef

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

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

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

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

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

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 41:37–53CrossRef

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

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

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

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

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

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

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

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

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

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 151:170–178CrossRef

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 44:847–854CrossRef

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

Title: UV-induced skin cancer at workplace and evidence-based prevention
Authors: Birgitta Kütting
Hans Drexler
Publication date: 01-12-2010
Publisher: Springer-Verlag
Published in: International Archives of Occupational and Environmental Health / Issue 8/2010
Print ISSN: 0340-0131
Electronic ISSN: 1432-1246
DOI: https://doi.org/10.1007/s00420-010-0532-4

At a glance: The STEP trials

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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