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


CONCLUSIONS
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.
Kütting
Birgitta
B
Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, University of Erlangen- Nuremberg, Schillerstr. 25 + 29, 91054, Erlangen, Germany. birgitta.kuetting@ipasum.uni-erlangen.de
Drexler
Hans
H
D055317:Evidence-Based Practice; D006801:Humans; D009784:Occupational Diseases / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control*; D016273:Occupational Exposure / Q000009:adverse effects*; D011481:Protective Clothing; D012307:Risk Factors; D012878:Skin Neoplasms / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology / Q000517:prevention & control*; D013472:Sunlight / Q000009:adverse effects; D013473:Sunscreening Agents / Q000627:therapeutic use; D014466:Ultraviolet Rays / Q000009:adverse effects*
D013473:Sunscreening Agents