title: Nonmelanoma skin cancer in mountain guides: high prevalence and lack of awareness warrant development of evidence-based prevention tools.
abstract: OBJECTIVE
  Nonmelanoma skin cancer (NMSC) is the most common cancer in Switzerland and Europe. The main causative factor is exposure to ultraviolet radiation, which puts outdoor workers in general at a higher risk of developing NMSC than indoor workers. However, few studies have clinically examined the risk of developing NMSC to outdoor workers, especially mountain guides. We aimed to investigate the prevalence of NMSC and corresponding precancerous lesions, and the associated risk behaviour of mountain and ski guides in order to develop future prevention programmes.
  
  
  METHODS
  We conducted a cross-sectional study including mountain and ski guides from southern Germany, who underwent a full-body skin check-up by a dermatologist. We assessed their NMSC awareness and risk behaviour using a paper-based questionnaire.
  
  
  RESULTS
  Of the 62 state-certified mountain and ski guides (55 men, 7 women; mean age 52.9 ± 13.4 years) included in this study, 27 (43.5%) were diagnosed with NMSC or its premalignant stages. In addition, 59.7% of the participants expressed the opinion that their protection from ultraviolet radiation exposure needs to be improved; 83.6% requested further information on NMSC, and 48.5% had never undergone a skin check-up or consulted a dermatologist before.
  
  
  CONCLUSIONS
  Mountain and ski guides are at a high risk for developing NMSC. Their unmet medical needs indicate an underestimation of NMSC prevalence, which is usually based on reports by insurance companies, and offer the chance for developing evidence-based awareness and prevention tools that can be promoted to individuals with other outdoor jobs.
authors.affiliation: Department of Dermatology and Allergy, University Hospital Klinikum rechts der Isar, Technical University of Munich, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Zink
authors.affiliation: Department of Dermatology and Allergy, University Hospital Klinikum rechts der Isar, Technical University of Munich, Germany.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Koch
authors.affiliation: Department of Dermatology and Allergy, University Hospital Klinikum rechts der Isar, Technical University of Munich, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Seifert
authors.affiliation: Research Unit of Molecular Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Munich, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Rotter
authors.affiliation: Department of Medicine II, University Hospital Klinikum rechts der Isar, Technical University of Munich, Germany.
authors.forename: Christoph D
authors.initials: CD
authors.lastname: Spinner
authors.affiliation: Department of Dermatology and Allergy, University Hospital Klinikum rechts der Isar, Technical University of Munich, Germany.
authors.forename: Tilo
authors.initials: T
authors.lastname: Biedermann
mesh_terms: D000328:Adult; D000368:Aged; D001364:Awareness; D003430:Cross-Sectional Studies; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009051:Mountaineering; D016273:Occupational Exposure / Q000706:statistics & numerical data*; D015995:Prevalence; D012865:Skiing; D012878:Skin Neoplasms / Q000453:epidemiology* / Q000473:pathology*; D014466:Ultraviolet Rays / Q000009:adverse effects