Abstract
BackgroundA two-fold risk increase to develop basal cell carcinoma was seen in outdoor workers exposed to high solar UV radiation compared to controls. However, there is an ongoing discussion whether histopathological subtype, tumor localization and Fitzpatrick phototype may influence the risk estimates.ObjectivesTo evaluate the influence of histological subtype, tumor localization and Fitzpatrick phototype on the risk to develop basal cell carcinoma in highly UV-exposed cases and controls compared to those with moderate or low solar UV exposure.MethodsSix hundred forty-three participants suffering from incident basal cell carcinoma in commonly sun-exposed anatomic sites (capillitium, face, lip, neck, dorsum of the hands, forearms outside, décolleté) of a population-based, case-control, multicenter study performed from 2013 to 2015 in Germany were matched to controls without skin cancer. Multivariate logistic regression analysis was conducted stratified for histological subtype, phototype 1/2 and 3/4. Dose-response curves adjusted for age, age2, sex, phototype and non-occupational UV exposure were calculated.ResultsParticipants with high versus no (OR 2.08; 95% CI 1.24–3.50; p = 0.006) or versus moderate (OR 2.05; 95% CI 1.15–3.65; p = 0.015) occupational UV exposure showed a more than two-fold significantly increased risk to develop BCC in commonly UV-exposed body sites. Multivariate regression analysis did not show an influence of phototype or histological subtype on risk estimates. The restriction of the analysis to BCC cases in commonly sun-exposed body sites did not influence the risk estimates. The occupational UV dosage leading to a 2-fold increased basal cell carcinoma risk was 6126 standard erythema doses.ConclusionThe risk to develop basal cell carcinoma in highly occupationally UV-exposed skin was doubled consistently, independent of histological subtype, tumor localization and Fitzpatrick phototype.
Highlights
A two-fold risk increase to develop basal cell carcinoma was seen in outdoor workers exposed to high solar UV radiation compared to controls
The occupational UV dosage leading to a 2-fold increased basal cell carcinoma risk was 6126 standard erythema doses
Nodular basal cell carcinoma (BCC) (n = 403, 62.7%) was the most common histopathological subtype followed by sclerodermiform (n = 145, 22.6%) and superficial (n = 28, 4.4%) BCC (Table 2)
Summary
A two-fold risk increase to develop basal cell carcinoma was seen in outdoor workers exposed to high solar UV radiation compared to controls. Based on the available epidemiological evidence at this time, informed decision making to consider BCC related to occupational UV exposure as an occupational disease was not possible. This was due to the limited methodological quality of almost all included studies. Quality was low because of low numbers of included participants, poorly classified indoor and outdoor tasks and occupations, lack of quantification of occupational and leisure time UV exposure, lack of controlling for relevant confounders and high risk of bias [9]. Previous work from our group showed that individuals with high occupational solar UV exposure had a 1.84-fold significantly increased BCC risk (95% CI 1.19–2.83) compared with no occupational UV exposure and a 1.97-fold significantly increased BCC risk (95% CI 1.20–3.22) compared with moderate occupational UV exposure [10]
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