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Wendt A, Möhner M. Occupational solar exposure and basal cell carcinoma. A review of the epidemiologic literature with meta-analysis focusing on particular methodological aspects. Eur J Epidemiol 2024; 39:13-25. [PMID: 38170370 PMCID: PMC10810945 DOI: 10.1007/s10654-023-01061-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 09/11/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Numerous epidemiologic studies and a few systematic reviews have investigated the association between occupational solar exposure and basal cell carcinoma (BCC). However, previous reviews have several deficits with regard to included and excluded studies/risk estimates and the assessment of risk of selection bias (RoSB). Our aim was to review epidemiologic studies with a focus on these deficits and to use meta-(regression) analyses to summarize risk estimates. METHODS We systematically searched PubMed (including MEDLINE) and Embase for epidemiologic studies. Study evaluation considered four main aspects of risk of bias assessments, i.e. Selection of subjects (selection bias); Exposure variables; Outcome variables; Data analysis. RESULTS Of 56 identified references, 32 were used for meta-(regression) analyses. The overall pooled risk estimate for BCC comparing high/present vs. low/absent occupational solar exposure was 1.20 (95% CI 1.02-1.43); among studies without major deficits regarding data analysis, it was 1.10 (95% CI 0.91-1.33). Studies with low and high RoSB had pooled risk estimates of 0.83 (95% CI 0.73-0.93) and 1.95 (95% CI 1.42-2.67), respectively. The definitions of exposure and outcome variables were not correlated with study risk estimates. Studies with low RoSB in populations with the same latitude or lower than Germany had a pooled risk estimate of 1.01 (95% CI 0.88-1.15). CONCLUSION Due to the different associations between occupational solar exposure and BCC among studies with low and high RoSB, we reason that the current epidemiologic evidence base does not permit the conclusion that regular outdoor workers have an increased risk of BCC.
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Affiliation(s)
- Andrea Wendt
- Federal Institute for Occupational Safety and Health, Nöldnerstr. 40-42, 10317, Berlin, Germany.
| | - Matthias Möhner
- Federal Institute for Occupational Safety and Health, Nöldnerstr. 40-42, 10317, Berlin, Germany
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Togsverd-Bo K, Philipsen PA, Haedersdal M, Wulf HC. Organ transplant recipients express enhanced skin autofluorescence and pigmentation at skin cancer sites. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2018; 188:1-5. [PMID: 30173090 DOI: 10.1016/j.jphotobiol.2018.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 06/30/2018] [Accepted: 08/08/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Skin autofluorescence and pigmentation can estimate photodamage and sun exposure. These techniques may quantify differences in actinic damage between high-risk organ transplant recipients (OTRs) and immunocompetent patients. METHODS Age and gender-matched OTRs (n = 15) and immunocompetent controls (n = 15) with a new keratinocyte carcinoma (KC) were included. We measured skin autofluorescence (370 nm excitation, F370) and skin pigmentation at five standardized body sites; and determined black light-evaluated solar lentigines on the shoulders and photosensitivity to UVA and simulated solar radiation (SSR) as minimal erythema doses (MED). RESULTS F370 autofluorescence values were enhanced at KC site versus other body sites in OTRs (2208 vs. 1458-1898 AU, p < 0.05). Compared with non-OTRs, OTRs expressed higher F370 autofluorescence at KC site (2208 vs. 1385 arbitrary units AU, p = 0.01) and the shoulder (1898 vs. 1525, p = 0.05). Likewise, OTRs had increased skin pigmentation (25.0 vs. 20.8 pigment%, p = 0.05) and solar lentigines (3.5 vs. 3.0, p = 0.048) on the shoulders. MED tests showed increased UVA photosensitivity in OTRs (2.4 vs. 1.7 times higher than expected, p = 0.03), whereas SSR photosensitivity was similar. CONCLUSION Quantified F370 autofluorescence, skin pigmentation, and density of solar lentigines could serve to assess photodamage in OTR. Increased UVA photosensitivity may account for higher skin photodamage.
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Affiliation(s)
- Katrine Togsverd-Bo
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Denmark.
| | | | - Merete Haedersdal
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Denmark
| | - Hans Christian Wulf
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Denmark
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Togsverd-Bo K, Philipsen PA, Hædersdal M, Wulf HCO. Skin autofluorescence reflects individual seasonal UV exposure, skin photodamage and skin cancer development in organ transplant recipients. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2017; 178:577-583. [PMID: 29272850 DOI: 10.1016/j.jphotobiol.2017.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 10/10/2017] [Accepted: 12/01/2017] [Indexed: 11/30/2022]
Abstract
IMPORTANCE Ultraviolet radiation (UVR)-induced skin cancers varies among organ transplant recipients (OTRs). To improve individual risk assessment of skin cancer, objectively quantified skin photodamage is needed. OBJECTIVES We measured personal UVR-exposure dose in OTRs and assessed the relation between individual UVR exposure, skin cancer and objectively measured photodamage in terms of skin autofluorescence, pigmentation, and black light-evaluated solar lentigines. MATERIALS AND METHODS Danish OTRs with (n=15) and without a history of skin cancer (n=15) kept sun diaries from May to September and wore personal dosimeters recording time-stamped UVR doses in standard erythema doses (SED). Photodamage was quantified as skin autofluorescence with excitation at 370nm (F370) and 430nm (F430), skin pigmentation (pigment protection factor, PPF), and black light-evaluated solar lentigines. RESULTS OTRs with skin cancer received a higher UVR dose than OTRs without skin cancer (median 116 SED vs. 67 SED, p=0.07) and UVR exposure doses were correlated with increased PPF (p=0.052) and F370 on the shoulder (F370shoulder) (p=0.04). We found that skin cancer was associated with F370shoulder (OR 10.53, CI 3.3-31,938; p=0.018) and time since transplantation (OR 1.34, CI 0.95-1.91, p=0.097). A cut-off at 7.2 arbitrary units, 89% of OTRs with skin cancer had F370shoulder values above 7.2 arbitrary units and F370shoulder was additionally related to patient age (p=0.09) and black light-evaluated solar lentigines (p=0.04). CONCLUSION F370 autofluorescence indicates objectively measured photodamage and may be used for individual risk assessment of skin cancer development in OTRs.
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Affiliation(s)
- Katrine Togsverd-Bo
- Department of Dermato-venerology, Bispebjerg University Hospital, 2400 Copenhagen, Denmark.
| | | | - Merete Hædersdal
- Department of Dermato-venerology, Bispebjerg University Hospital, 2400 Copenhagen, Denmark
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Dobos G, Trojahn C, D'Alessandro B, Patwardhan S, Canfield D, Blume-Peytavi U, Kottner J. Effects of intrinsic aging and photodamage on skin dyspigmentation: an explorative study. JOURNAL OF BIOMEDICAL OPTICS 2016; 21:66016. [PMID: 27330007 DOI: 10.1117/1.jbo.21.6.066016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 05/25/2016] [Indexed: 06/06/2023]
Abstract
Photoaging is associated with increasing pigmentary heterogeneity and darkening of skin color. However, little is known about age-related changes in skin pigmentation on sun-protected areas. The aim of this explorative study was to measure skin color and dyspigmentation using image processing and to evaluate the reliability of these parameters. Twenty-four volunteers of three age-groups were included in this explorative study. Measurements were conducted at sun-exposed and sun-protected areas. Overall skin-color estimates were similar among age groups. The hyper- and hypopigmentation indices differed significantly by age groups and their correlations with age ranged between 0.61 and 0.74. Dorsal forearm skin differed from the other investigational areas (p<0.001). We observed an increase in dyspigmentation at all skin areas, including sun-protected skin areas, already in young adulthood. Associations between age and dyspigmentation estimates were higher compared to color parameters. All color and dyspigmentation estimates showed high reliability. Dyspigmentation parameters seem to be better biomarkers for UV damage than the overall color measurements.
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Affiliation(s)
- Gabor Dobos
- Charité-Universitätsmedizin Berlin, Clinical Research Center for Hair and Skin Science, Department of Dermatology and Allergy, Charitéplatz 1, 10117 Berlin, Germany
| | - Carina Trojahn
- Charité-Universitätsmedizin Berlin, Clinical Research Center for Hair and Skin Science, Department of Dermatology and Allergy, Charitéplatz 1, 10117 Berlin, Germany
| | - Brian D'Alessandro
- Canfield Scientific Inc., 4 Wood Hollow Road, Parsippany, New Jersey 07054, United States
| | - Sachin Patwardhan
- Canfield Scientific Inc., 4 Wood Hollow Road, Parsippany, New Jersey 07054, United States
| | - Douglas Canfield
- Canfield Scientific Inc., 4 Wood Hollow Road, Parsippany, New Jersey 07054, United States
| | - Ulrike Blume-Peytavi
- Charité-Universitätsmedizin Berlin, Clinical Research Center for Hair and Skin Science, Department of Dermatology and Allergy, Charitéplatz 1, 10117 Berlin, Germany
| | - Jan Kottner
- Charité-Universitätsmedizin Berlin, Clinical Research Center for Hair and Skin Science, Department of Dermatology and Allergy, Charitéplatz 1, 10117 Berlin, Germany
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Radespiel-Tröger M. Berufliche UV-Belastung und Hautkrebs. ZENTRALBLATT FUR ARBEITSMEDIZIN ARBEITSSCHUTZ UND ERGONOMIE 2014. [DOI: 10.1007/bf03346247] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Bakos L, Mastroeni S, Bonamigo RR, Melchi F, Pasquini P, Fortes C. A melanoma risk score in a Brazilian population. An Bras Dermatol 2013; 88:226-32. [PMID: 23739694 PMCID: PMC3750885 DOI: 10.1590/s0365-05962013000200007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 06/04/2012] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Important risk factors for cutaneous melanoma (CM) are recognized, but standardized scores for individual assessment must still be developed. OBJECTIVES The objective of this study was to develop a risk score of CM for a Brazilian sample. METHODS To verify the estimates of the main risk factors for melanoma, derived from a meta-analysis (Italian-based study), and externally validate them in a population in southern Brazil by means of a case-control study. A total of 117 individuals were evaluated. Different models were constructed combining the summary coefficients of different risk factors, derived from the meta-analysis, multiplied by the corresponding category of each variable for each participant according to a mathematical expression. RESULTS the variable that best predicted the risk of CM in the studied population was hair color (AUC: 0.71; 95% CI: 0.62-0.79). Other important factors were freckles, sunburn episodes, and skin and eye color. Consideration of other variables such as common nevi, elastosis, family history, and premalignant lesions did not improve the predictive ability of the models. CONCLUSION The discriminating capacity of the proposed model proved to be superior or comparable to that of previous risk models proposed for CM.
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Affiliation(s)
- Lucio Bakos
- PhD - Professor of Dermatology – Universidade Federal do Rio Grande do
Sul (UFRGS) – Porto Alegre (RS), Brazil
| | - Simona Mastroeni
- MSc - Statistician - Clinical Epidemiology Unit Istituto Dermopatico
dell'Immacolata (IDI-IRCCS) –Rome, Italy
| | - Renan Rangel Bonamigo
- PhD - Professor of Dermatology - Universidade Federal de Ciências da
Saúde de Porto Alegre (UFCSPA) – Porto Alegre, Brazil
| | - Franco Melchi
- MD - Dermatologist - VIII Dermatology Unit Istituto Dermopatico
dell'Immacolata (IDI-IRCCS) – Rome, Italy
| | - Paolo Pasquini
- MD - Dermatologist - Clinical Epidemiology Unit Istituto Dermopatico dell'Immacolata (IDI-IRCCS) – Rome, Italy
| | - Cristina Fortes
- PhD - Epidemiologist - Clinical Epidemiology Unit Istituto Dermopatico
dell'Immacolata (IDI-IRCCS) – Rome, Italy
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Wendt J, Schanab O, Binder M, Pehamberger H, Okamoto I. Site-dependent actinic skin damage as risk factor for melanoma in a central European population. Pigment Cell Melanoma Res 2012; 25:234-42. [PMID: 22145962 DOI: 10.1111/j.1755-148x.2011.00946.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Sun exposure is causal for melanoma but is subject to bias of recall so that it is difficult to dissect the role of particular patterns of sun exposure. In this hospital-based case-control study (n = 1991), we aimed to analyze pigmentation traits and signs of actinic damage at different anatomic locations as markers of melanoma risk in central European patients. Although all signs of actinic damage (freckling, wrinkling and solar lentigos) were significantly associated with melanoma risk in multivariate logistic regression models adjusting for age and sex, the strongest associations were observed for the dorsal parts of the body: adjusted odds ratios [OR] were 4.22 for wrinkling on the neck, 3.43 for solar lentigos and 3.37 for freckling on the back (all P < 0.001), respectively. These associations were independent of age, sex and pigmentation traits. Our results indicate that signs of actinic damage are predictors of melanoma risk, particularly on the back.
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Affiliation(s)
- Judith Wendt
- Division of General Dermatology, Department of Dermatology, Medical University of Vienna, Vienna, Austria
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Bauer A, Diepgen T, Schmitt J. Is occupational solar ultraviolet irradiation a relevant risk factor for basal cell carcinoma? A systematic review and meta-analysis of the epidemiological literature. Br J Dermatol 2011; 165:612-25. [DOI: 10.1111/j.1365-2133.2011.10425.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Samson N, Fink B, Matts PJ, Dawes NC, Weitz S. Visible changes of female facial skin surface topography in relation to age and attractiveness perception. J Cosmet Dermatol 2010; 9:79-88. [PMID: 20618552 DOI: 10.1111/j.1473-2165.2010.00489.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Evolutionary psychology suggests that a woman's age and physical appearance are important mate choice criteria. Given that changes in female facial skin surface topography are important, prominent visible signs of aging, male perceptual sensitivity for variation in this trait may also affect preference and attractiveness judgment. METHODS Two experiments were conducted to investigate perception (Experiment 1) and noticeability (Experiment 2) of skin surface topography manipulations in facial images of six British women, aged 45-65 years. In Experiment 1 skin surface topography cues were completely removed on the cheeks, the "crow's feet" area adjacent to the eye, under the eyes, above the upper lip, and on the forehead while, in Experiment 2, it was removed gradually (20% increments) on the forehead and around the eyes. In both experiments, stimuli were presented to American and German participants (total N = 300, aged 15-55 years) in omnibus pair-wise combinations (within-face). With each pair, respondents were asked to select that face which they considered as younger looking (Experiments 1 and 2) and more attractive (Experiment 1). RESULTS Faces with skin surface topography cues removed were judged significantly younger and more attractive than their original (unmodified) counterparts, with modifications on the forehead and around the eyes showing the highest differences. In these areas, participants were able to detect at least a 20% visual change in skin surface topography. CONCLUSIONS The results support the assertion that even small changes in skin surface topography affect the perceptions of a woman's facial age and attractiveness and may, thus, also influence men's mate preferences.
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Affiliation(s)
- Nadine Samson
- Department of Sociobiology, University of Goettingen, Goettingen, Germany
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Guinot C, Malvy DJM, Latreille J, Ezzedine K, Galan P, Tenenhaus M, Ambroisine L, Hercberg S, Tschachler E. Sun-reactive Skin Type in 4912 French Adults Participating in the SU.VI.MAX Study¶. Photochem Photobiol 2007. [DOI: 10.1111/j.1751-1097.2005.tb01465.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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12
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Gandini S, Sera F, Cattaruzza MS, Pasquini P, Zanetti R, Masini C, Boyle P, Melchi CF. Meta-analysis of risk factors for cutaneous melanoma: III. Family history, actinic damage and phenotypic factors. Eur J Cancer 2005; 41:2040-59. [PMID: 16125929 DOI: 10.1016/j.ejca.2005.03.034] [Citation(s) in RCA: 471] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2005] [Accepted: 03/16/2005] [Indexed: 12/16/2022]
Abstract
A systematic meta-analysis of observational studies of melanoma and family history, actinic damage and phenotypic factors was conducted as part of a comprehensive meta-analysis of all major risk factors for melanoma. Following a systematic literature search, relative risks were extracted from 60 studies published before September 2002. Fixed and random effects models were used to obtain pooled estimates for family history (RR = 1.74, 1.41-2.14), skin type (I vs. IV: RR = 2.09, 1.67-2.58), high density of freckles (RR = 2.10, 1.80-2.45), skin colour (Fair vs. Dark: RR = 2.06, 1.68-2.52), eye colour (Blue vs. Dark: RR = 1.47, 1.28-1.69) and hair colour (Red vs. Dark: RR = 3.64, 2.56-5.37), pre-malignant and skin cancer lesions (RR = 4.28, 2.80-6.55) and actinic damage indicators (RR = 2.02, 1.24-3.29). Sub-group analysis and meta-regression were carried out to explore sources of between-study variation and bias. Sensitivity analyses investigated reliability of results and publication bias. Latitude and adjustment for phenotype were two study characteristics that significantly influenced the estimates.
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Affiliation(s)
- Sara Gandini
- Department of Epidemiology and Biostatistics, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy.
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Gandini S, Sera F, Cattaruzza MS, Pasquini P, Picconi O, Boyle P, Melchi CF. Meta-analysis of risk factors for cutaneous melanoma: II. Sun exposure. Eur J Cancer 2005; 41:45-60. [PMID: 15617990 DOI: 10.1016/j.ejca.2004.10.016] [Citation(s) in RCA: 790] [Impact Index Per Article: 41.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2004] [Revised: 09/20/2004] [Accepted: 10/14/2004] [Indexed: 01/09/2023]
Abstract
A systematic revision of the literature was conducted in order to undertake a comprehensive meta-analysis of all published observational studies on melanoma. An extensive analysis of the inconsistencies and variability in the estimates was performed to provide some clues about its Epidemiology. Following a systematic literature search, relative risks (RRs) for sun exposure were extracted from 57 studies published before September 2002. Intermittent sun exposure and sunburn history were shown to play considerable roles as risk factors for melanoma, whereas a high occupational sun exposure seemed to be inversely associated to melanoma. The country of study and adjustment of the estimates adjuste for phenotype and photo-type were significantly associated with the variability of the intermittent sun exposure estimates (P = 0.024, 0.003 and 0.030, respectively). For chronic sun exposure, inclusion of controls with dermatological diseases and latitude resulted in significantly different data (P = 0.05 and 0.031, respectively). Latitude was also shown to be important (P = 0.031) for a history of sunburn; studies conducted at higher latitudes presented higher risks for a history of sunburns. Role of country, inclusion of controls with dermatological diseases and other study features seemed to suggest that "well conducted" studies supported the intermittent sun exposure hypothesis: a positive association for intermittent sun exposure and an inverse association with a high continuous pattern of sun exposure.
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Affiliation(s)
- Sara Gandini
- Department of Epidemiology and Biostatistics, European Institute of Oncology, IRCCS Via Ripamonti 435, 20141 Milan, Italy.
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Guinot C, Malvy DJM, Latreille J, Ezzedine K, Galan P, Tenenhaus M, Ambroisine L, Hercberg S, Tschachler E. Sun-reactive Skin Type in 4912 French Adults Participating in the SU.VI.MAX Study¶. Photochem Photobiol 2005. [DOI: 10.1562/2004-08-04-ra-260r1.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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The effects of sunlight on the skin of Asians. ACTA ACUST UNITED AC 2001. [DOI: 10.1016/s1568-461x(01)80039-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Lock-Andersen J, Fine Olivarius F, Haedersdal M, Poulsen T, Wulf HC. Minimal erythema dose in UV-shielded and UV-exposed skin predicted by skin reflectance measured pigmentation. Skin Res Technol 1999. [DOI: 10.1111/j.1600-0846.1999.tb00121.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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