title: Climatic Factors and Epidemiologic Characteristics of Head and Neck Skin Malignancies in Osijek Baranja County, Croatia.
abstract: OBJECTIVE
  The aim of this study was to investigate and compare the incidence and epidemiological characteristics of head and/or neck skin malignancies in Osijek-Baranja County, Croatia, and to connect them with relative climatic indicators such as the number and intensity of sunny and cloudy days over a longer period of time.
  
  
  METHODS
  The study included patients from Osijek Baranja County with confirmed pathohistological diagnosis of the head and/or neck malignancies from January 1, 2004 to December 31, 2012. The patients were analyzed according to gender, age, residence, occupation, type and location of the neoplasm, and hair and eye colour. The analysis of climatic elements (mean monthly and annual cloudiness values, mean monthly and annual sum values of sunny days) for a period of 50 years (1961-2011) based on the data of the Croatian Meteorological and Hydrological Service for the investigated area was performed.
  
  
  RESULTS
  The study included a total of 2,952 patients: 1,487 (50.4%) males and 1,465 (49.6%) females, representing the estimated annual incidence of 104/100,000. The mean age was 72 years. The patients were mostly from rural areas, 1,952 (66.2%); 2,137 (72.4%) worked outdoors: 907 farmers (42.4%) and 889 construction workers (41.6%). Given the type of neoplasm, the most common was a basal cell cancer (BCC) in 2,160 patients (73.2%). Malignant melanoma was found in 93 patients (3.1%). The most common localizations were face (839 cases, 28.7%) and nose (643 cases, 22.0%). Males had a significantly higher number of planocellular malignancies--341 (56.6%) than females--262 (43.4%) (p=0.005). The median age of the patients was 67 years. There were no significant differences in types of malignancies, place of residence, workplace, or occupation (with respect to working outdoors or indoors). It has been shown that the ears and lips are significantly more affected by squamous cell malignancies (p=0.039 and p<0.001) compared to the neck, eye and head with malignant melanoma (p=0.004, p<0.001, and p=0.026) and the nose where basal cell neoplasms (p=0.002) prevail. There were no significant differences in the type and frequency of malignant neoplasms in relation to hair and eye colour of the patients. The last 50 years in Osijek-Baranja County have seen a declining trend in the number of cloudy days and upward trend in the mean annual sum of sunny days. When compared, the increase in sunny days results in a higher number of patients suffering from malignant melanoma (ρ=0.695, p=0.038).
  
  
  CONCLUSIONS
  It is obvious that malignant neoplasms of the skin, head and neck occur after decades of exposure, and as a cumulative effect of exposure to risk factors. A direct exposure to sun seems to play an important role, especially with regard to melanoma. Nevertheless, further research is needed.
authors: Department of Surgery, University Hospital Centre Osijek, Osijek, Croatia.
authors: Želimir
authors: Ž
authors: Orkić
authors: Faculty Of Medicine, J. J. Strossmayer University of Osijek, Osijek, Croatia.
authors: Dinko
authors: D
authors: Puntarić
authors: Faculty Of Medicine, J. J. Strossmayer University of Osijek, Osijek, Croatia.
authors: Domagoj
authors: D
authors: Vidosavljević
authors: Institute for Emergency Medicine of Zagreb County, Velika Gorica, Croatia.
authors: Ida
authors: I
authors: Puntarić
authors: Biology Department, Faculty of Science, Zagreb, Croatia.
authors: Eda
authors: E
authors: Puntarić
authors: Department of Chemistry, J. J. Strossmayer University of Osijek, Osijek, Croatia.
authors: Vlatka
authors: V
authors: Gvozdić
authors: Croatian Institute for Public Health, Zagreb, Croatia.
authors: Dijana
authors: D
authors: Mayer
authors: County General Hospital, Vinkovci, Croatia.
authors: Marina
authors: M
authors: Vidosavljević
authors: Faculty Of Medicine, J. J. Strossmayer University of Osijek, Osijek, Croatia.
authors: Andrijana Muller
authors: AM
authors: Vranješ
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017523:Croatia / Q000453:epidemiology; D003710:Demography; D005260:Female; D006258:Head and Neck Neoplasms / Q000453:epidemiology* / Q000473:pathology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012878:Skin Neoplasms / Q000453:epidemiology* / Q000473:pathology
keywords: epidemiology; head and neck; intensity of solar radiation; malignant neoplasms of the skin