title: The relationship between occupational sun exposure and non-melanoma skin cancer: clinical basics, epidemiology, occupational disease evaluation, and prevention.
abstract: BACKGROUND
  The cumulative effect of solar ultraviolet (UV) radiation is responsible for the worldwide increase in non-melanoma skin cancer, a category that includes squamous cell carcinoma and its precursors (the actinic keratoses) as well as basal-cell carcinoma. Non-melanoma skin cancer is the most common type of cancer in areas of the world with a light-skinned population. The occupational exposure to UV radiation is high in many outdoor occupations; recent studies suggest that persons working in such occupations are more likely to develop non-melanoma skin cancer.
  
  
  METHODS
  On the basis of a selective review of the literature, we present the current state of knowledge about occupational and non-occupational UV exposure and the findings of meta-analyses on the association of outdoor activity with non-melanoma skin cancer. We also give an overview of the current recommendations for prevention and for medicolegal assessment.
  
  
  RESULTS
  Recent meta-analyses have consistently documented a significantly higher risk of squamous cell carcinoma of the skin among persons who work outdoors (odds ratio [OR] 1.77, 95% confidence interval [CI] 1.40-2.22, p<0.001). There is also evidence for an elevated risk of basal-cell carcinoma (OR 1.43, 95% CI 1.23-1.66, p = 0.0001), but the effect is of lesser magnitude and the study findings are not as uniform.
  
  
  CONCLUSIONS
  The association of occupational exposure to solar UV radiation with squamous cell carcinoma, including actinic keratosis, has been conclusively demonstrated. It follows that, in Germany, suspected non-melanoma skin cancer in persons with high occupational exposure to UV radiation should be reported as an occupational disease under § 9, paragraph 2 of the Seventh Book of the German Social Code (Sozialgesetzbuch, SGB VII). Preventive measures are urgently needed for persons with high occupational exposure to UV radiation.
authors.affiliation: Department of Clinical and Experimental Occupatioal Dermatology, Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University of Bochum, Germany. fartasch@ipa.ruhr-uni-bochum.de
authors.forename: Manigé
authors.initials: M
authors.lastname: Fartasch
authors.forename: Thomas Ludwig
authors.initials: TL
authors.lastname: Diepgen
authors.forename: Jochen
authors.initials: J
authors.lastname: Schmitt
authors.forename: Hans
authors.initials: H
authors.lastname: Drexler
mesh_terms: D015984:Causality; D004781:Environmental Exposure / Q000517:prevention & control / Q000706:statistics & numerical data; D006801:Humans; D008545:Melanoma / Q000453:epidemiology / Q000517:prevention & control; D009381:Neoplasms, Radiation-Induced / Q000453:epidemiology* / Q000517:prevention & control*; D009784:Occupational Diseases / Q000453:epidemiology* / Q000517:prevention & control*; D015995:Prevalence; D011481:Protective Clothing / Q000706:statistics & numerical data; D018570:Risk Assessment; D012878:Skin Neoplasms / Q000453:epidemiology* / Q000517:prevention & control*; D013472:Sunlight; D013473:Sunscreening Agents / Q000627:therapeutic use*; D014466:Ultraviolet Rays
chemical_list: D013473:Sunscreening Agents