Basal cell carcinoma risk and solar UV exposure in occupationally relevant anatomic sites: do histological subtype, tumor localization and Fitzpatrick phototype play a role? A population-based case-control study

Abstract

Background A 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. Objectives To 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. Methods Six 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. Results Participants 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. Conclusion The risk to develop basal cell carcinoma in highly occupationally UV-exposed skin was doubled consistently, independent of histological subtype, tumor localization and Fitzpatrick phototype.

Clinicopathologic and Histomorphological Aspect of Basal Cell Carcinoma in Dr. Cipto Mangunkusumo Hospital: A Retrospective Analysis of Twenty Years Experience

“…24 Referring to the theory that BCC is strongly associated with UV exposure, this result is relevant because the head, face, and neck areas are most frequently exposed to sunlight. 25 The theory that other BCC precursors originate from hair follicles supports the finding because head, face, and neck region contain more hair follicles than any other region of the body. 26,27 However, a discrepancy in the pattern of UV exposure occurred in this study.…”

New methods for assessing secondary performance attributes of sunscreens suitable for professional outdoor work

“…Sunscreens should – as a secondary measure – therefore just add to other protective measures and should especially be applied to areas of the body that cannot be protected with clothing (e.g., forehead, ears, neck, and hands). It needs to be emphasized, however, that AK, cSCC and BCC in outdoor workers predominantly occur in exactly these body areas [ 10 – 12 , 41 ]. Thus, these body areas are of pivotal importance for adequate photo-protection and skin cancer prevention at workplaces.…”

Workplace exposure to UV radiation and strategies to minimize cancer risk

“…97% of study participants had Fitzpatrick phototype III or less). 40 The researchers found a doubling of the risk for SCC for a lifetime occupational exposure of 6348 SED, with the corresponding figure for BCC being 7945 SED; after adjusting for occupational exposure, non-occupational exposure was not significantly associated with risk for either cancer. In both cases these exposures were around the 90th percentile of occupational exposure for the subjects.…”