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Rönsch H, Rocholl M, Ludewig M, Staudt A, Langner M, Steeb T, Wilke A, John SM, Berking C, Beissert S, Bauer A. Sonnenschutz bei Beschäftigten im Freien. Entwicklung und Validierung von standardisierten Fragebögen für Verhalten und Wissen. J Dtsch Dermatol Ges 2024; 22:665-674. [PMID: 38730530 DOI: 10.1111/ddg.15378_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 01/11/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND AND OBJECTIVES Outdoor workers are at increased risk of developing non-melanoma skin cancer. We aimed to address the lack of validated German-language measurement instruments for outdoor workers' sun safety behavior and knowledge by compiling and validating two questionnaires. PARTICIPANTS AND METHODS By expert consensus, items for the assessment of protective behavior (OccuSun) were compiled based on existing instruments. For knowledge, a translation of the Skin Cancer and Sun Knowledge (SCSK) scale was selected. After a pre-test, a validation study including 68 outdoor workers (62% female) was conducted in 2020. RESULTS The retest reliability was r = 0.93 (95% confidence interval: 0.86-0.96) for the protection score and rs = 0.78 (0.67-0.86) for the knowledge score. Protective behaviors were correlated with respective diary data (0.38 ≤ rs ≤ 0.74, p < 0.001) and skin pigmentation changes (-0.23 ≥ rs ≥ -0.42, 0.007 ≤ p ≤ 0.165) but not with self-reported sunburn frequency (0.21 ≥ rs ≥ -0.04). CONCLUSIONS Among German outdoor workers, two questionnaires for the assessment of sun protection behavior (OccuSun) and knowledge (SCSK) demonstrated good reliability. The OccuSun had generally good validity. Both instruments are fit for subsequent validation to determine their sensitivity to change.
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Affiliation(s)
- Henriette Rönsch
- Klinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden
| | - Marc Rocholl
- Institut für Gesundheitsforschung und Bildung, Abteilung für Dermatologie, Umweltmedizin und Gesundheitstheorie, Universität Osnabrück
- Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm) an der Universität Osnabrück
| | - Michaela Ludewig
- Institut für Gesundheitsforschung und Bildung, Abteilung für Dermatologie, Umweltmedizin und Gesundheitstheorie, Universität Osnabrück
- Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm) an der Universität Osnabrück
| | - Andreas Staudt
- Institut und Poliklinik für Arbeits- und Sozialmedizin, Medizinische Fakultät, Technische Universität Dresden
- Abteilung für Methoden der Community Medicine, Institut für Community Medicine, Universitätsmedizin Greifswald
| | - Mathias Langner
- Institut für Klinische Chemie und Laboratoriumsmedizin (IKL), Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden
| | - Theresa Steeb
- Klinik für Dermatologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen, Europäische Metropolregion Nürnberg, Erlangen
| | - Annika Wilke
- Institut für Gesundheitsforschung und Bildung, Abteilung für Dermatologie, Umweltmedizin und Gesundheitstheorie, Universität Osnabrück
- Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm) an der Universität Osnabrück
| | - Swen Malte John
- Institut für Gesundheitsforschung und Bildung, Abteilung für Dermatologie, Umweltmedizin und Gesundheitstheorie, Universität Osnabrück
- Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm) an der Universität Osnabrück
| | - Carola Berking
- Klinik für Dermatologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen, Europäische Metropolregion Nürnberg, Erlangen
| | - Stefan Beissert
- Klinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden
| | - Andrea Bauer
- Klinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden
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Ürün YG, Ürün M. Comparison of Socio-demographic Characteristics, Tumour Features, and Surgical Treatment Outcomes in Phenotypic Variants of Basal Cell Carcinoma. Indian J Dermatol 2024; 69:212-220. [PMID: 39119316 PMCID: PMC11305496 DOI: 10.4103/ijd.ijd_755_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024] Open
Abstract
Background Basal cell carcinoma (BCC) cases exhibit variations in tumour number, location, and growth patterns. While some patients develop only one BCC, approximately one-third of patients later develop one or more additional lesions. Aims The aim of the study was to identify risk factors for further BCC lesions in patients with different phenotypic presentations. Materials and Methods We retrospectively evaluated 1052 histopathologically diagnosed tumours of 861 patients, who were divided into four phenotypic presentation groups according to tumour number at initial diagnosis and during follow-up. Age, sex, tumour characteristics, surgical margins, re-excision and residual tumour rates were compared. Univariate and multivariate logistic regression analyses were performed to determine risk factors for multiple tumour development. Results There were 723 patients in the single presentation phenotype 1 (SPP1) group, 19 in the SPP-more group, 114 in the multiple presentation phenotype (MPP)-cluster initial group, and five patients in the MPP-cluster later group. Male sex was more common in the MPP-cluster later group (P = 0.028). The mean age was lower in the SPP1 and SPP-more groups (P = 0.002). Ear involvement was more common in the MPP-cluster later group (P < 0.05). Superficial and basosquamous subtypes were more common in the SPP-more and MPP-cluster later groups (P < 0.05). Re-excision and residual tumour rates were lowest in the SPP1 group (P < 0.05). Age over 69 years, male sex, and periorbital or upper extremity location were significant risk factors for multiple tumour development (P < 0.05). Limitations The limitations of our study include the inability to evaluate environmental risk factors, phenotypic and ethnic characteristics, and the short follow-up period for newly added patients. Conclusions Predicting different phenotypic presentations by taking the age, gender, and tumour characteristics (localization, histopathological subtype) of the patients into account may allow new tumours to be detected at an early stage.
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Affiliation(s)
- Yıldız Gürsel Ürün
- From the Department of Dermatology and Venereology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Mustafa Ürün
- From the Department of Dermatology and Venereology, Faculty of Medicine, Trakya University, Edirne, Turkey
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Rönsch H, Rocholl M, Ludewig M, Staudt A, Langner M, Steeb T, Wilke A, John SM, Berking C, Beissert S, Bauer A. Sun protection in outdoor workers - Development and validation of standardized questionnaires for behavior and knowledge. J Dtsch Dermatol Ges 2024; 22:665-673. [PMID: 38528320 DOI: 10.1111/ddg.15378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 01/11/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND AND OBJECTIVES Outdoor workers are at increased risk of developing non-melanoma skin cancer. We aimed to address the lack of validated German-language measurement instruments for outdoor workers' sun safety behavior and knowledge by compiling and validating two questionnaires. PARTICIPANTS AND METHODS By expert consensus, items for the assessment of protective behavior (OccuSun) were compiled based on existing instruments. For knowledge, a translation of the Skin Cancer and Sun Knowledge (SCSK) scale was selected. After a pre-test, a validation study including 68 outdoor workers (62% female) was conducted in 2020. RESULTS The retest reliability was r = 0.93 (95% confidence interval: 0.86-0.96) for the protection score and rs = 0.78 (0.67-0.86) for the knowledge score. Protective behaviors were correlated with respective diary data (0.38 ≤ rs ≤ 0.74, p < 0.001) and skin pigmentation changes (-0.23 ≥ rs ≥ -0.42, 0.007 ≤ p ≤ 0.165) but not with self-reported sunburn frequency (0.21 ≥ rs ≥ -0.04). CONCLUSIONS Among German outdoor workers, two questionnaires for the assessment of sun protection behavior (OccuSun) and knowledge (SCSK) demonstrated good reliability. The OccuSun had generally good validity. Both instruments are fit for subsequent validation to determine their sensitivity to change.
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Affiliation(s)
- Henriette Rönsch
- Department of Dermatology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Marc Rocholl
- Institute for Health Research and Education, Department of Dermatology, Environmental Medicine and Health Theory, Osnabrück University, Osnabrück, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at Osnabrück University, Osnabrück, Germany
| | - Michaela Ludewig
- Institute for Health Research and Education, Department of Dermatology, Environmental Medicine and Health Theory, Osnabrück University, Osnabrück, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at Osnabrück University, Osnabrück, Germany
| | - Andreas Staudt
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Department of Methods in Community Medicine, Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Mathias Langner
- Institute for Clinical Chemistry und Laboratory Medicine (IKL), University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Theresa Steeb
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen, European Metropolitan Region of Nuremberg, Erlangen, Germany
| | - Annika Wilke
- Institute for Health Research and Education, Department of Dermatology, Environmental Medicine and Health Theory, Osnabrück University, Osnabrück, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at Osnabrück University, Osnabrück, Germany
| | - Swen Malte John
- Institute for Health Research and Education, Department of Dermatology, Environmental Medicine and Health Theory, Osnabrück University, Osnabrück, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at Osnabrück University, Osnabrück, Germany
| | - Carola Berking
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen, European Metropolitan Region of Nuremberg, Erlangen, Germany
| | - Stefan Beissert
- Department of Dermatology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Andrea Bauer
- Department of Dermatology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Artosi F, Costanza G, Di Prete M, Garofalo V, Lozzi F, Dika E, Cosio T, Diluvio L, Shumak RG, Lambiase S, Di Raimondo C, Campa S, Piscitelli P, Miani A, Bianchi L, Campione E. Epidemiological and clinical analysis of exposure-related factors in non-melanoma skin cancer: A retrospective cohort study. ENVIRONMENTAL RESEARCH 2024; 247:118117. [PMID: 38218521 DOI: 10.1016/j.envres.2024.118117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 01/15/2024]
Abstract
BACKGROUND The incidence of non-melanoma skin cancers (NMSCs) increased over last decades, probably due to environmental concerns or to the increase of frail patients with age related comorbidities. Currently, the relationship of increasing global skin cancer rates with increased ultraviolet radiations (UVRs) resulting from stratospheric ozone depletion, global warming, and air pollution from fossil-fuel combustion. AIMS We conducted a retrospective epidemiological study including 546 NMSC patients managed at the Dermatology Unit of the Tor Vergata Hospital to highlight different trends of sun exposure or different comorbidities. METHODS Descriptive and inferential statistical analyses were performed to evidence differences between continous variable and Spearman rank test for dicotomical variables. Charlson Comorbidity Index was calculated to obtain the 10-years survival rate in order to identify the mean comorbidity burden of our patients. RESULTS Considering patients with comorbidities (73.81%), actinic keratoses (AKs) was the most frequent lesion. In patients with a history of previous melanoma, basal cell carcinoma (BCC) was predominant (ANOVA test, p < 0.05) with a statistically significant correlation (rho = 0.453; p < 0.01). Squamous cell carcinoma (SCC) showed a higher rate in arterial hypertension patients, followed by the chronic heart failure and hematologic neoplasms (60%, 29.7% and 32.1%, respectively) groups. Men were more affected than women, representing 61.54% of patients. Chronic sun exposure is directly correlated with SCC rho = 0.561; p < 0.01), whereas BCC correlated with a history of sunburns (rho = 0.312; p < 0.05). CONCLUSIONS History of photo-exposition had an important role on NMSC development especially for work or recreational reasons. Sex, age, and presence of comorbidities influenced different NMSC types. BCC was more frequent in younger patients, associated with melanoma and sunburns. The presence of SCC is associated with older patients and the hypertension group. AKs were diagnosed predominantly in oldest men, with a chronic sun-exposure history, and hematologic neoplasms group.
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Affiliation(s)
- Fabio Artosi
- Dermatology Unit, Policlinico Tor Vergata, System Medicine Department, University of Tor Vergata, Rome, Italy, via Montpellier 1, 00133, Rome, Italy.
| | - Gaetana Costanza
- Unit of Virology, Department of Experimental Medicine, University of Rome Tor Vergata, via Montpellier 1, 00133, Rome, Italy.
| | - Monia Di Prete
- Dermatopathology Laboratory, Istituti Fisioterapici Ospitalieri, Istituto San Gallicano, via Fermo Ognibene 23, 00144, Rome, Italy.
| | - Virginia Garofalo
- Dermatology Unit, Policlinico Tor Vergata, System Medicine Department, University of Tor Vergata, Rome, Italy, via Montpellier 1, 00133, Rome, Italy
| | - Flavia Lozzi
- Dermatology Unit, Policlinico Tor Vergata, System Medicine Department, University of Tor Vergata, Rome, Italy, via Montpellier 1, 00133, Rome, Italy.
| | - Emi Dika
- Dermatology, IRCCS Policlinico Sant'Orsola, via Massarenti 9, 40138, Bologna, Italy.
| | - Terenzio Cosio
- PhD Course Microbiology, Immunology, Infectious Diseases, and Transplants (MIMIT), Microbiology Section, Department of Experimental Medicine, University of Rome Tor Vergata, via Montpellier 1, 00133, Rome, Italy.
| | - Laura Diluvio
- Dermatology Unit, Policlinico Tor Vergata, System Medicine Department, University of Tor Vergata, Rome, Italy, via Montpellier 1, 00133, Rome, Italy.
| | - Ruslana Gaeta Shumak
- Dermatology Unit, Policlinico Tor Vergata, System Medicine Department, University of Tor Vergata, Rome, Italy, via Montpellier 1, 00133, Rome, Italy.
| | - Sara Lambiase
- Dermatology Unit, Policlinico Tor Vergata, System Medicine Department, University of Tor Vergata, Rome, Italy, via Montpellier 1, 00133, Rome, Italy.
| | - Cosimo Di Raimondo
- Dermatology Unit, Policlinico Tor Vergata, System Medicine Department, University of Tor Vergata, Rome, Italy, via Montpellier 1, 00133, Rome, Italy.
| | - Serena Campa
- Italian Society of Environmental Medicine, SIMA, Italy.
| | - Prisco Piscitelli
- Italian Society of Environmental Medicine, SIMA, Italy; University of Salento, Lecce, Italy.
| | - Alessandro Miani
- Italian Society of Environmental Medicine, SIMA, Italy; Department of Environmental Sciences and Policies, University of Milan, Milan, Italy.
| | - Luca Bianchi
- Dermatology Unit, Policlinico Tor Vergata, System Medicine Department, University of Tor Vergata, Rome, Italy, via Montpellier 1, 00133, Rome, Italy.
| | - Elena Campione
- Dermatology Unit, Policlinico Tor Vergata, System Medicine Department, University of Tor Vergata, Rome, Italy, via Montpellier 1, 00133, Rome, Italy.
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Wunderlich K, Suppa M, Gandini S, Lipski J, White JM, Del Marmol V. Risk Factors and Innovations in Risk Assessment for Melanoma, Basal Cell Carcinoma, and Squamous Cell Carcinoma. Cancers (Basel) 2024; 16:1016. [PMID: 38473375 DOI: 10.3390/cancers16051016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 02/22/2024] [Accepted: 02/28/2024] [Indexed: 03/14/2024] Open
Abstract
Skin cancer is the most frequently diagnosed cancer globally and is preventable. Various risk factors contribute to different types of skin cancer, including melanoma, basal cell carcinoma, and squamous cell carcinoma. These risk factors encompass both extrinsic, such as UV exposure and behavioral components, and intrinsic factors, especially involving genetic predisposition. However, the specific risk factors vary among the skin cancer types, highlighting the importance of precise knowledge to facilitate appropriate early diagnosis and treatment for at-risk individuals. Better understanding of the individual risk factors has led to the development of risk scores, allowing the identification of individuals at particularly high risk. These advances contribute to improved prevention strategies, emphasizing the commitment to mitigating the impact of skin cancer.
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Affiliation(s)
- K Wunderlich
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - M Suppa
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, 1070 Brussels, Belgium
- Department of Dermatology, Institute Jules Bordet, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - S Gandini
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, European Institute of Oncology, IRCCS, 20139 Milan, Italy
| | - J Lipski
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - J M White
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - V Del Marmol
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, 1070 Brussels, Belgium
- Department of Dermatology, Institute Jules Bordet, Université Libre de Bruxelles, 1070 Brussels, Belgium
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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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7
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Baldermann C, Laschewski G, Grooß JU. Impact of climate change on non-communicable diseases caused by altered UV radiation. JOURNAL OF HEALTH MONITORING 2023; 8:57-75. [PMID: 37799535 PMCID: PMC10548485 DOI: 10.25646/11653] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 06/26/2023] [Indexed: 10/07/2023]
Abstract
Background UV radiation can cause serious skin and eye diseases, especially cancers. UV-related skin cancer incidences have been increasing for decades. The determining factor for this development is the individual UV exposure. Climate change-induced changes in atmospheric factors can influence individual UV exposure. Methods On the basis of a topic-specific literature research, a review paper was prepared and supplemented by as yet unpublished results of the authors' own studies. The need for scientific research and development is formulated as well as primary prevention recommendations. Results Climate change alters the factors influencing UV irradiance and annual UV dose in Germany. First evaluations of satellite data for Germany show an increase in mean peak UV irradiance and annual UV dose for the last decade compared to the last three decades. Conclusions The climate change-related influences on individual UV exposure and the associated individual disease incidence cannot yet be reliably predicted due to considerable uncertainties. However, the current UV-related burden of disease already requires primary preventive measures to prevent UV-related diseases.
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Affiliation(s)
- Cornelia Baldermann
- Federal Office for Radiation Protection Section WR4 - Optical Radiation Neuherberg/Oberschleißheim, Germany
| | - Gudrun Laschewski
- Deutscher Wetterdienst Centre for Medical-Meteorological Research Freiburg, Germany
| | - Jens-Uwe Grooß
- Forschungszentrum Jülich GmbH Institute for Energy and Climate Research – Stratosphere (IEK-7) Jülich, Germany
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Degree of Actinic Elastosis Is a Surrogate of Exposure to Chronic Ultraviolet Radiation and Correlates More Strongly with Cutaneous Squamous Cell Carcinoma than Basal Cell Carcinoma. Life (Basel) 2023; 13:life13030811. [PMID: 36983966 PMCID: PMC10055681 DOI: 10.3390/life13030811] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/13/2023] [Accepted: 03/16/2023] [Indexed: 03/19/2023] Open
Abstract
(1) Background: Keratinocyte cancer (KC) is associated with exposure to ultraviolet (UV) radiation. However, data are controversial as to whether chronic UV exposure or high intermittent UV exposure are key drivers of carcinogenesis in cutaneous squamous cell carcinoma (cSCC) and basal cell carcinoma (BCC). Prolonged sun exposure of the skin causes photo-aging, which is associated with actinic elastosis, a condition characterized by the degeneration of elastin in the upper dermis, which is assessable via conventional histology. In this study, we aimed to compare the degree of actinic elastosis in different types of KC with regard to various patient characteristics. (2) Methods: We defined a semiquantitative score for the degree of actinic elastosis ranging from 0 = none to 3 = total loss of elastic fibers (basophilic degeneration). The extent was measured histometrically by two independent dermatohistopathologists in the immediate vicinity of 353 KC. The scores were merged and matched with tumor types (cSCC and BCC with subtypes), and clinical variables such as body site, sex and age. (3) Results: As expected, the degree of actinic elastosis correlated with age. However, it was significantly higher in cSCC compared to BCC irrespective of age, sex, body site and tumor subtypes. (4): Conclusions: Lifetime sun exposure may be estimated via routine histology using this scoring technique for actinic elastosis as a surrogate marker. cSCCs are more strongly associated with chronic UV exposure than BCCs, even in sun-exposed localizations such as the face.
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Photoprotection in occupational dermatology. Photochem Photobiol Sci 2023:10.1007/s43630-023-00385-6. [PMID: 36853496 DOI: 10.1007/s43630-023-00385-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 01/30/2023] [Indexed: 03/01/2023]
Abstract
Skin cancer has become a substantial matter of public health and in the workplace, accounting for a significant share of all reported occupational diseases. The most important external factor in the development of skin cancer is exposure to solar ultraviolet radiation. Outdoor workers have already been identified as a high-risk category. The need for interventions to improve the sun protection behavior of outdoor workers has recently been understood. Outdoor workers' risk perceptions and attitudes toward sun protection methods are likely to influence practical sun protection behavior at work, and despite the fact that many workers have expressed interest in improving their sun protection behavior, outdoor workers' unique needs are still neglected. Occupational dermatology is predicted to become more concerned with photoprotection in the decades ahead. Preventive action against the rapidly increasing number skin cancer cases is in great demand around the globe. In terms of preventive measures, the full range of available options should be used as needed to address the current difficulties in a goal-oriented way. This will almost certainly only be achievable if preventative efforts on a collective and individual level are successfully paired with support from policymakers to inspire long-term change.
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Wittlich M, Westerhausen S, Strehl B, Versteeg H, Stöppelmann W. The GENESIS-UV study on ultraviolet radiation exposure levels in 250 occupations to foster epidemiological and legislative efforts to combat nonmelanoma skin cancer. Br J Dermatol 2023; 188:350-360. [PMID: 36635210 DOI: 10.1093/bjd/ljac093] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/26/2022] [Accepted: 11/08/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Several hundred million of the 3 billion formally employed people worldwide are at risk from high levels of solar ultraviolet radiation (UVR). Chronic light damage to the skin can lead to nonmelanoma skin cancer (NMSC), especially when irradiation is too high and is acquired for decades. However, data with uniform metrics, high resolution over time and in-depth occupational profiles are not available. OBJECTIVES To build a worldwide usable matrix of UVR exposure in occupations and to show use cases for the data. METHODS One thousand test persons were recruited to wear electronic data logger dosimeters during their working time for 7 months each. The measurements yielded 3.7 billion data points for around 48 000 days with high-quality data capture covering more than 250 occupations and 650 activities. Scientific evaluation of the data included daily and half-hourly means, geographical transfer calculations to the world, threshold exceedance quotas, transcriptome effects, and occupational disease estimates. RESULTS A compendium for global use is presented. In-depth analyses and the resulting implications for research have been elaborated to directly link exposure data to effects in the human body. Interestingly, the annual irradiances of the different occupations span a wide range of values: from about 650 to 50 standard erythemal doses, with different distributions over the months. Detailed exposure data per occupation were derived, and the risk on an occupational or activity basis assuming different exposure level quotas was quantified. This showed that, for example, in temperate latitudes, all activities with a duration of > 2 h outdoors are associated with increased NMSC risk. CONCLUSIONS We offer our work to enable sound studies on the nature of ultraviolet-induced skin cancer, dose-response relationships, intermittency of skin exposure, and derivation of limit values. Sociological studies on prevention are now possible. Practitioners may use the findings for their daily work with employees.
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Affiliation(s)
- Marc Wittlich
- Department 'Accident Prevention: Digitalisation - Technologies'
| | | | - Benjamin Strehl
- Department 'Accident Prevention: Digitalisation - Technologies'
| | - Helmut Versteeg
- Department 'Exposure and Risk Assessment', Institute for Occupational Safety and Health of the German Social Accident Insurance, Alte Heerstraße 111, 53757 Sankt Augustin, Germany
| | - Wiho Stöppelmann
- Department 'Exposure and Risk Assessment', Institute for Occupational Safety and Health of the German Social Accident Insurance, Alte Heerstraße 111, 53757 Sankt Augustin, Germany
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11
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Symanzik C, John SM. Sun protection and occupation: Current developments and perspectives for prevention of occupational skin cancer. Front Public Health 2022; 10:1110158. [PMID: 36620257 PMCID: PMC9816330 DOI: 10.3389/fpubh.2022.1110158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
A substantial proportion of all reported occupational illnesses are constituted by skin cancer, making this disease a serious public health issue. Solar ultra-violet radiation (UVR) exposure is the most significant external factor in the development of skin cancer, for which the broad occupational category of outdoor workers has already been identified as high-risk group. Sun protection by deploying adequate technical, organizational, and person-related measures has to be understood as a functional aspect of workplace safety. To prevent skin cancers brought on by-typically cumulative-solar UVR exposure, outdoor workers must considerably lower their occupationally acquired solar UVR doses. Estimating cumulative sun exposure in outdoor workers requires consideration of the level of solar UVR exposure, the tasks to be done in the sun, and the employees' solar UVR preventive measures. Recent studies have highlighted the necessity for measures to enhance outdoor workers' sun protection behavior. In the coming decades, occupational dermatology is expected to pay increasing attention to sun protection at work. Also, the field of dermato-oncology will likely be concerned with sky-rocketing incidences of occupational skin cancers. The complete range of available alternatives should be utilized in terms of preventive actions, which seems pivotal to handle the present and future challenges in a purposeful manner. This will almost definitely only be possible if politicians' support is effectively combined with communal and individual preventive actions in order to spur long-term transformation.
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Affiliation(s)
- Cara Symanzik
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), Osnabrück University, Osnabrück, Germany,Department of Dermatology, Environmental Medicine and Health Theory, Institute for Health Research and Education (IGB), Faculty of Human Sciences, Osnabrück University, Osnabrück, Germany,*Correspondence: Cara Symanzik ✉
| | - Swen Malte John
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), Osnabrück University, Osnabrück, Germany,Department of Dermatology, Environmental Medicine and Health Theory, Institute for Health Research and Education (IGB), Faculty of Human Sciences, Osnabrück University, Osnabrück, Germany
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12
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Cherrie JW, Cherrie MPC. Workplace exposure to UV radiation and strategies to minimize cancer risk. Br Med Bull 2022; 144:45-56. [PMID: 35973164 PMCID: PMC9744745 DOI: 10.1093/bmb/ldac019] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/01/2022] [Accepted: 07/22/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Workplace exposure to solar ultraviolet (UV) causes malignant melanoma and non-melanoma skin cancer. The evidence for beneficial effects of solar UV exposure in reducing the risks for other cancers is increasing. The intensity of UV radiation at the Earth's surface is dependent on latitude, but even in northern European countries exposure can be high enough for outdoor work to cause skin cancer. GROWING POINTS Awareness of the health risks and benefits of occupational solar UV exposure is poor. Actions to reduce the risk of skin cancer have been identified and employers should recognize their responsibility to actively manage these risks. There is evidence for reduced risks for breast, ovarian and colorectal cancer and possibly other cancers linked to solar UV exposure. SOURCES OF DATA This narrative review draws on published scientific articles and material designed to assist identifying strategies to protect workers from solar UV exposure. AREAS OF AGREEMENT Solar UV exposure can be harmful. Wavelengths in the UVB range are more effective in causing erythema and DNA damage. Solar UV is the main source of vitamin D for most people. Primary and secondary prevention for skin cancer can potentially eliminate these risks but the evidence for effectiveness is limited. AREAS OF CONTROVERSY Potential health benefits of UV exposure, particularly for reduced cancer risk. Determining and communicating optimal exposure to maximize health benefits. The risk of non-melanoma skin cancers may be more than doubled for some workers in temperate latitudes. AREAS TIMELY FOR DEVELOPING RESEARCH Exposure-response epidemiological studies; studies of the health benefits of occupational UV exposure; studies of the effectiveness of intervention strategies to prevent skin cancer. Use of low-cost UV sensors in workplaces.
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Affiliation(s)
- J W Cherrie
- IOM, Research Avenue North, Edinburgh EH14 4AP, UK.,Institute of Biological Chemistry, Biophysics and Bioengineering, Heriot Watt University, Edinburgh EH14 4AS, UK
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Kulinich H, Prokhorova E, Moskalenko M, Nasonova A, Danyliuk S. Clinical observations of generalized and inoperable locally advanced forms of basal cell carcinoma. УКРАЇНСЬКИЙ РАДІОЛОГІЧНИЙ ТА ОНКОЛОГІЧНИЙ ЖУРНАЛ 2022. [DOI: 10.46879/ukroj.2.2022.88-99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background. Basal cell carcinoma (BCC) occupies around 80% of all the cases of diagnosed skin cancer (according to American Cancer Society). In various countries of the world the morbidity rate of BCC differs due to the main predisposing factor of BCC development – ultraviolet radiation. In Ukraine, according to National Cancer Registry, 15882 new cases of non-melanoma skin cancer were registered in 2019–2020. Standardized morbidity rate of this pathology increased by 2,6% compared to 2018. Basal cell cancer commonly recurs (according to different experts, the rate varies from 10% to 80%), at the same time, distant metastases are diagnosed quite rarely. Understanding contribution of Hedgehog (Hh) signaling pathway to carcinogenesis of BCC has become a serious achievement in molecular biology. In spite of relatively benign course of BCC and variety of treatment methods of this disease, there is a high risk of recurrence, and in some patients, lesions may progress to such extent that they become unsuitable for local therapy which makes it urgent to search for alternatives to surgery and radiation therapy.
Purpose – to study the peculiarities of course, treatment, development of complications of recurrent, locally advanced, metastatic inoperable BCC by the example of clinical cases. Materials and methods. Clinical observation of female patient K., 73 years old, who was undergoing treatment in the Department of Clinical Oncology and Hematology by reason of multiple BCC lesions (observation time 14 years) and female patient D., 42 years old, who was undergoing treatment in the Department of Radiation Pathology and Palliative Care by reason of aggressive course of locally advanced form of basalioma (observation time 29 years). Observation and treatment were performed in the State Organization «Grigoriev Institute for Medical Radiology and Oncology of the National Academy of Medical Sciences of Ukraine».
Results. The clinical cases of observation and different stages of treatment of patients with constantly recurring aggressive BCC over a long period of time, 14 and 29 years, are demonstrated. Metastasing of BCC is confirmed in both cases, local advancement is shown, various methods of treatment were used: surgery, radiation therapy, cryodestruction, chemotherapy. Difficulty of patients' management is shown, especially when all available methods are used up. Treatment of complications of special therapy methods, multistage restoring plastic surgeries using different methods of plastic repair are described.
Conclusions. Treating recurrent, metastatic, and locally advanced inoperable forms of BCC when one runs out of possibilities of the main treatment methods – surgery, radiation therapy, chemotherapy is a difficult task which requires further development of modern technology and treatment methods.
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14
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Advanced basal cell carcinoma: What dermatologists need to know about diagnosis. J Am Acad Dermatol 2022; 86:S1-S13. [PMID: 35577405 DOI: 10.1016/j.jaad.2022.03.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 03/07/2022] [Accepted: 03/09/2022] [Indexed: 12/07/2022]
Abstract
Basal cell carcinoma (BCC) is the most common human cancer, with approximately 3.6 million cases diagnosed each year. About 2000 deaths annually in the United States are attributed to basal and squamous cell skin cancers. There is a direct link between ultraviolet exposure and the development of BCC, as UV exposure damages DNA and induces mutations in tumor suppressor genes. Aberrations in the hedgehog pathway can also result in BCC, highlighted by the fact that most cases of sporadic BCCs have been found to have mutations in different genes involved in the hedgehog pathway. There are several genetic syndromes that are associated with BCCs, including basal cell nevus syndrome, xeroderma pigmentosum, Bazex-Dupré-Christol syndrome, Rombo syndrome, and Oley syndrome. Other risk factors include age, male gender, occupational hazards, radiation, and immunosuppression. BCCs are not typically staged but are instead stratified by their risk of recurring or metastasizing. Locally advanced BCCs are those tumors that are not amenable to surgery or radiation therapy.
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Abstract
Despite the serious health consequences of UV radiation, protection against UV radiation is even now still not a matter of course. The population has a largely realistic view of UV radiation-related health risks but this does not seem to instigate a change in personal risk assessments and towards an adequate UV protection behavior. This is not least due to the partly contradictory statements and recommendations regarding the positive and negative health effects, also from the scientific community. A harmonization as well as a collation of the statements and activities of individual players in UV protection related to the prevention of UV-related diseases gives the key messages the necessary strength to make UV protection a matter of course in society. To this end, the UV Protection Alliance was initiated by the Federal Office for Radiation Protection (BfS). This article reports on the UV Protection Alliance, presents the partners in the Alliance, the goals of the UV Protection Alliance, previous results of work by the Alliance and actions and interventions of the Alliance partners. The public impact of the UV Protection Alliance is explained and an outlook is given on future tasks of the Alliance.
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Affiliation(s)
- Cornelia Baldermann
- Koordinierungsstelle UV-Schutz-Bündnis am Bundesamt für Strahlenschutz, Bundesamt für Strahlenschutz, Neuherberg, Deutschland.
- Koordinierungsstelle UV-Schutz-Bündnis am Bundesamt für Strahlenschutz, Fachgebiet WR4 - Optische Strahlung, Bundesamt für Strahlenschutz, Ingolstädter Landstr. 1, 85764, Neuherberg, Deutschland.
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Rocholl M, Weinert P, Bielfeldt S, Laing S, Wilhelm KP, Ulrich C, John SM. New methods for assessing secondary performance attributes of sunscreens suitable for professional outdoor work. J Occup Med Toxicol 2021; 16:25. [PMID: 34225747 PMCID: PMC8256554 DOI: 10.1186/s12995-021-00314-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/23/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Outdoor workers (OW) are highly exposed to solar ultraviolet radiation (UVR) and thus at increased risk for developing skin cancer. An essential part of an overall strategy to reduce workplace UVR-exposure to OW's skin is the usage of sunscreens. However, compliance with regular sunscreen usage seems to be low, as products are usually designed for recreational sun exposure and thus do not meet the requirements of physically active OW. To date, no standardized test procedures assess the suitability of sunscreens for professional use. The aim of this pilot study was to develop standardized methods of testing secondary performance attributes (PA) to represent real-life working conditions of outdoor work. METHODS Ten sunscreen products, carefully selected after a detailed market survey of all relevant producers available on the German market, were evaluated regarding their suitability for professional outdoor work on 24 healthy volunteers in a newly designed test procedure. In addition to three standardized efficacy characteristics, i.e., sun protection factor, water-resistance, and UVA protection, we evaluated each PA involving parameters typically associated with outdoor workplaces. RESULTS We developed standardized methods for objectifying the suitability of sunscreen products for professional outdoor work. The test procedures used are well feasible and appropriate for testing the PA because they represent practical working conditions in detail - although the degree of discriminability of single test methods varied. The claimed sun protection factor (SPF) of the products was confirmed; bio-stability of the SPF after physical activity was achieved in most cases. While most products hardly irritate the eyes and are quickly absorbed, the evaluation of the subjective skin feeling and non-slip grip is inconsistent. CONCLUSIONS In this pilot study, for the first time secondary PA are defined and examined. Although further objectification of the PA assessment as well as the establishment of minimum standards should be sought, the new methods could already complement the so far mandatory labels and in this way provide a significant impetus for the current scientific and political focus on the improvement of occupational health in highly UVR-exposed OW.
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Affiliation(s)
- Marc Rocholl
- Institute for Health Research and Education, Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Germany. .,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Germany.
| | - Patricia Weinert
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Germany
| | - Stephan Bielfeldt
- proDERM Institute of Applied Dermatological Research GmbH, Kiebitzweg 2, 22869, Schenefeld, Hamburg, Germany
| | - Sabrina Laing
- proDERM Institute of Applied Dermatological Research GmbH, Kiebitzweg 2, 22869, Schenefeld, Hamburg, Germany
| | - Klaus Peter Wilhelm
- proDERM Institute of Applied Dermatological Research GmbH, Kiebitzweg 2, 22869, Schenefeld, Hamburg, Germany
| | - Claas Ulrich
- Department of Dermatology and Allergy, Skin Cancer Center, Charité-Universitätsmedizin, Charitéplatz 1, 10117, Berlin, Germany
| | - Swen Malte John
- Institute for Health Research and Education, Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Germany
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[Update on occupational skin cancer-basal cell carcinoma and solar UV exposure]. Hautarzt 2021; 72:484-492. [PMID: 33884436 DOI: 10.1007/s00105-021-04818-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Outdoor workers are occupationally exposed to significantly higher ultraviolet (UV) doses than the rest of the population. Recent data show a doubling of basal cell carcinoma (BCC) risk in outdoor workers with high occupational UV exposure. OBJECTIVES To examine the stability and robustness of BCC risk estimators. METHODS Sensitivity analyses to test model assumptions considering socioeconomic status, influence of matching procedure, gender and latency, regional differences (east/west), urban/rural cases/controls, and dual diagnoses (squamous cell carcinoma [SCC]/actinic keratoses grade III [AKIII]/Bowen disease [BD] and BCC) were performed. RESULTS BCC risk was consistently higher for high occupationally UV-exposed individuals than for intermediate UV-exposed individuals, regardless of matching procedure, latency, regional differences (east/west), urban/rural recruitment of cases/controls, and dual diagnoses (SCC/AKIII/BD and BCC), sex, and socioeconomic status. CONCLUSION The risk estimator for the association between exposure to solar UV radiation at work and the risk of developing BCC showed a high degree of stability and robustness for all variables investigated. The analyses support the recently published findings on the doubling of BCC risk in outdoor workers with high occupational UV exposure.
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Elsner P. Berufsdermatologie: Was ist neu im Jahr 2021? AKTUELLE DERMATOLOGIE 2021. [DOI: 10.1055/a-1319-2789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
ZusammenfassungZum 01. 01. 2021 tritt eine weitreichende Reform des Berufskrankheitenrechts in Kraft, wonach der sog. „Unterlassungszwang“ als Voraussetzung für die Anerkennung einer Berufskrankheit abgeschafft wird. Die Berufskrankheit (BK) Haut Nr. 5101 wird daher neu definiert als „schwere oder wiederholt rückfällige Hauterkrankungen“; ob die Hauterkrankung zur Unterlassung der hautgefährdenden Tätigkeit zwingt und diese unterlassen wurde oder ob Versicherte ihre Tätigkeit fortführen, ist für die Anerkennung einer BK 5101 nicht mehr von Belang. Sind die Voraussetzungen der Schwere und/oder der wiederholten Rückfälligkeit gegeben, ist eine BK-Anzeige zu erstellen und, nach geplanter Ergänzung des Vertrags Ärzte-Unfallversicherungsträger, gleichzeitig ein Hautarztbericht zu erstatten. Mit einer größeren Zahl anerkannter Fälle einer BK 5101 ist zu rechnen; für diese Versicherten besteht dann ein lebenslanges Anrecht auf die dermatologische Versorgung der BK-Folgen durch die Gesetzliche Unfallversicherung und ggf. auch auf eine Rentenzahlung. Zumindest für die Fälle von leichten beruflichen Hauterkrankungen behält das seit 1972 bewährte Hautarztverfahren weiterhin seine Bedeutung.Keine Änderungen ergeben sich 2021 für die Berufskrankheiten Nr. 5102 (Hautkrebs durch PAK) und 5103 (Plattenepithelkarzinome und multiple aktinische Keratosen durch solare UV-Strahlung). Neue Erkenntnisse ergaben sich jedoch für UV-bedingte Basalzellkarzinome (BZK). In einer jüngst publizierten großen multizentrischen Fall-Kontroll-Studie konnte gezeigt werden, dass bei Personen mit hoher beruflicher UV-Exposition ein mehr als 2-fach signifikant erhöhtes Risiko für BZK an beruflich UV-exponierten Körperlokalisationen besteht. Damit ist für diese Personengruppe das sog. „Verdoppelungsrisiko“ nachgewiesen, und auf der Basis dieser neuen Erkenntnisse ist die Meldung entsprechender Fälle mit einer BK-Anzeige nach § 9 Abs. 2 SGB VII möglich.
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Affiliation(s)
- P. Elsner
- Klinik für Hautkrankheiten, Universitätsklinikum Jena
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Abstract
Ultraviolet (UV) radiation is the main risk factor for the development of melanocytic and nonmelanocytic skin cancer. UVA and UVB radiation are of particular importance in photocarcinogenesis. Depending on the wavelength, mechanisms of tumor initiation and promotion include direct DNA damage and proinflammatory processes. In recent years, the number of skin cancer cases in Germany has continuously increased. In addition to regular skin check-ups, use of suitable textile protection and sunscreens play a central role in the prevention of cancer development. As dermatologists, it is our task to regularly inform our patients about the consequences of excessive sun exposure and to adequately inform them about necessary protective devices.
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