title: Farmers develop more aggressive histologic subtypes of basal cell carcinoma. Experience from a Tertiary Hospital in Northern Greece.
abstract: BACKGROUND
  Ultraviolet radiation plays an important role in the pathogenesis of non-melanoma skin cancer. Outdoor workers, including farmers, experience higher exposure levels compared to the general population. Available literature data suggest that occupational ultraviolet exposure represents an independent risk factor for squamous cell carcinoma; whereas for basal cell carcinoma (BCC) this association still remains unclarified.
  
  
  OBJECTIVE
  To analyse the epidemiological, clinical and histological data of patients diagnosed with BCC, and correlate them with outdoor occupation in farmers.
  
  
  METHODS
  Individuals with histologically diagnosed BCCs, between September 2013 and September 2015, were included in the study. Their medical data, including epidemiological, clinical and histological characteristics, were recorded and analysed in conjunction with the occupation. Farmers were identified based on their specific public health insurance.
  
  
  RESULTS
  Three hundred and forty patients, with 542 BCCs were included in the study. One hundred and twenty (35.3%) were farmers. Mean age of farmers was lower than non-farmers (66.0 ± 9.1 years vs. 75 ± 6.6 years, Mann-Whitney U-test, P < 0.001). Farmers had a sixfold higher probability for exhibiting photodamaged skin (OR = 6.02, 95% CI: 3.66-9.90, P < 0.001). Farmer workers were more likely to exhibit infiltrative or morpheaform BCC, but less likely to develop superficial BCC.
  
  
  CONCLUSIONS
  Our results indicate a higher risk of earlier development of more aggressive histological subtypes of BCCs in farmers. Photodamage was also more common in this group. Primary and secondary prevention strategies focusing on outdoor workers, including farmers, are mandatory.
authors.affiliation: First Department of Dermatology, Aristotle University of Thessaloniki, Greece.
authors.forename: Z
authors.initials: Z
authors.lastname: Apalla
authors.affiliation: First Department of Dermatology, Aristotle University of Thessaloniki, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Lallas
authors.affiliation: First Department of Dermatology, Aristotle University of Thessaloniki, Greece.
authors.forename: E
authors.initials: E
authors.lastname: Sotiriou
authors.affiliation: First Department of Dermatology, Aristotle University of Thessaloniki, Greece.
authors.forename: E
authors.initials: E
authors.lastname: Lazaridou
authors.affiliation: First Department of Dermatology, Aristotle University of Thessaloniki, Greece.
authors.forename: E
authors.initials: E
authors.lastname: Vakirlis
authors.affiliation: Second Department of Dermatology, Aristotle University of Thessaloniki, Greece.|Department of Dermatology, St.Pierre Hospital, Brussels, Belgium.
authors.forename: M
authors.initials: M
authors.lastname: Trakatelli
authors.affiliation: Skin Cancer Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Kyrgidis
authors.affiliation: First Department of Dermatology, Aristotle University of Thessaloniki, Greece.
authors.forename: D
authors.initials: D
authors.lastname: Ioannides
mesh_terms: D002280:Basal Cell Carcinoma / Q000453:epidemiology* / Q000473:pathology; D000067565:Farmers; D005260:Female; D006115:Greece / Q000453:epidemiology; D006801:Humans; D008297:Male; D009381:Neoplasms, Radiation-Induced / Q000453:epidemiology* / Q000473:pathology; D012878:Skin Neoplasms / Q000453:epidemiology* / Q000473:pathology; D062606:Tertiary Care Centers / Q000458:organization & administration*