Hautkrebs durch natürliche UV‐Strahlung als Berufskrankheit – Voraussetzungen für eine Meldung und Anerkennung

Abstract

In Germany over 2.5 million employees have an increased risk of skin cancer due to their occupational exposure to natural UV-irradiation. The medical consultation board "Occupational diseases" of the Ministry of Labor and Social affairs has investigated the association between occupational UV-irradiation and skin cancer risk and recommends to add the following new occupational disease into the appendix1 of the German ordinance on occupational diseases: "Squamous cell carcinoma and multiple actinic keratosis due to natural UV-irradiation". In this article we report in the view of the German Society of Occupational and Environmental Dermatology (ABD) and the German Statutory accident insurance (DGUV), whose criteria have to be fulfilled for the notification and recognition of an occupational skin cancer due to natural UV-irradiation.

New developments in occupational dermatology

“…The lesion(s) in question therefore has (have) to be a cutaneous squamous cell carcinoma or multiple actinic keratoses that have occurred in areas occupationally exposed to the sun. Actinic keratoses are considered multiple -in the context of this occupational disease -if more than five individual lesions have developed over the course of 12 months or if there is field cancerization of more than 4 cm 2 [12,14]. The definition of "multiple actinic keratoses" chosen by the expert committee is not based on scientific evidence but has been established deliberately to exclude "minor-disease cases" from being recognized as Table 1 Cumulative non-occupational UV exposure under the basic assumption of individual recreational UV exposure of 130 SEDs/year (figures are provided by age at the onset of skin cancer) and the additionally required 40 % occupational UV exposure under the assumption of occupational UV exposure of 170 SEDs/year (in Germany) in individuals working exclusively outdoors.…”

“…The estimated number of work years required to fulfill the criteria of BK 5103 are given. (SED: standard erythema dose = 100 J/m²) [12,14]. Corresponding individual UV exposure has to be determined in the context of the recognition process.…”

“…occupational disease [14]. This means that, with respect to actinic keratoses, at least six individual lesions have to be present, either at the same time at the time of diagnosis or occurring within a period of 12 months.…”

“…Biologically and legally, non-genital Bowen's disease is to be considered equivalent to actinic keratosis, and therefore also has to occur as multiple lesions or extend to an area of > 4 cm 2 . Progression to Bowen's carcinoma is possible; with respect to insurance laws, the latter is then to be considered equivalent to squamous cell carcinoma [14].…”

The collision tumor in the assessment of non‐melanoma skin cancer caused by occupational UV exposure

“…Zur Einschätzung des Vorliegens eines berufsbedingten Plattenepithelkarzinoms und seiner Vorstufen wird eine überwiegend berufliche Verursachung bei einer zusätzlichen natürlichen UV-Strahlungsexposition von 40 % gegenüber der durchschnittlichen Exposition der Allgemeinbevölkerung von 130 SED (Standarderythemdosis) pro Jahr in den betroffenen Hautarealen angenommen [1,2]. Dies liegt in der überadditiven Dosis-Wirkungs-Beziehung begründet, die besagt, dass es bei einer 1%igen Zunahme der biologisch wirksamen UV-Strahlung zu einer Zunahme des Plattenepithelkarzinomrisikos um 2,5 % kommt, sodass bei einer zusätzlichen beruflichen Exposition von 40 % das Risiko an einem Plattenepithelkarzinom zu erkranken verdoppelt ist [7,8]…”