title: The experience of a tertiary referral centre in Romania on basal cell carcinomas in outdoor workers: why to assess?
abstract: BACKGROUND
  Published epidemiological literature indicates that outdoor workers are at significantly increased risk for developing basal cell carcinomas.
  
  
  OBJECTIVE
  The main objective is to identify basal cell carcinoma features in patients with prolonged occupational exposure to UV radiation and compare them to basal cell carcinoma in patients with no occupational exposure to UV radiation.
  
  
  METHODS
  Data regarding age, gender, living area, occupation, number of lesions, involved anatomic site and histologic subtype of tumor were collected from the charts of 321 patients diagnosed with basal cell carcinoma in our department between 01.01.2013-31.12.2014. We divided the patient population in which the occupation was accurately identified in two study groups: occupations with UV exposure (OW), and non-UV exposed occupations (IW) and we compared the clinical and histologic features of the lesions in the two groups.
  
  
  RESULTS
  The most affected area in both groups was the facial "mask area". The cheek was second most affected area in exposed group whereas the scalp area was the second most affected in the non-exposed group. The nodular pattern is the most numerous in both groups (30 lesions in OW group and 15 lesions in the IW group with a mean number of lesions of 1.57±0.90 and 1.27±0.46, respectively) with the mixed type being the second most frequent type for both groups. However, for the OW group the mixed type with an aggressive component was the second most frequent one, while in the non-exposed group, the mixed type with non-aggressive components was the second most frequent, the difference being statistically significant. A multinomial logistic regression analysis was conducted to predict the presence of histopathologically aggressive lesions using gender, age, exposure and anatomical site out of which UV exposure and 3 main anatomical sites (mask zone, cheek and torso) were selected in the final analysis. The probability of the model chi-square (9.430), p = .05, supports a relationship between the dependent variable and the independent variables.
  
  
  CONCLUSIONS
  Our data suggest that in Romania patients diagnosed with basal cell carcinoma, occupationally exposed to UV radiation, develop more frequently lesions on the "mask area" of the face; furthermore, prediction of the histo-pathologically aggressive lesions may be supported by the presence of occupational UV exposure and anatomical site (mask zone, cheek and torso) involved.Also, these patients may be at a higher risk to develop more aggressive histologic subtype BCCs. Although limited by a number of factors, especially the small number of subjects, these data suggest the necessity of conducting both retrospective and prospective studies on clinical and histological types of BCCs evolving in patients working outdoor along with identifying additional risk factors.
authors.affiliation: Dermato-oncology Research Unit, Colentina Clinical Hospital, Bucharest, Romania.|Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
authors.forename: C M
authors.initials: CM
authors.lastname: Salavastru
authors.affiliation: Hauttumor Centrum der Charité, Berlin, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Ulrich
authors.affiliation: 2nd Department of Dermatology, Colentina Clinical Hospital, Bucharest, Romania.
authors.forename: S
authors.initials: S
authors.lastname: Cretu
authors.affiliation: Occupational Medicine Department, University of Medicine and Pharmacy Tirgu-Mures, Tirgu-Mures, Romania.
authors.forename: H R
authors.initials: HR
authors.lastname: Moldovan
authors.affiliation: Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.|2nd Department of Dermatology, Colentina Clinical Hospital, Bucharest, Romania.
authors.forename: G S
authors.initials: GS
authors.lastname: Tiplica
mesh_terms: D000368:Aged; D002280:Basal Cell Carcinoma / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009381:Neoplasms, Radiation-Induced / Q000175:diagnosis / Q000453:epidemiology*; D016273:Occupational Exposure; D012017:Referral and Consultation; D012383:Romania / Q000453:epidemiology; D012878:Skin Neoplasms / Q000175:diagnosis / Q000453:epidemiology*; D062606:Tertiary Care Centers / Q000458:organization & administration*