Non-melanoma skin cancer: The hidden epidemic faced by outdoor workers

Non-melanoma skin cancer: The hidden epidemic faced by outdoor workers
© iStock/SeventyFour

We talk to Professor Swen Malte John, Chair of the EADV Task Force on occupational skin disease, who emphasises the magnitude of the neglected disease, non-melanoma skin cancer.

Non-melanoma skin cancer (NMSC) is a form of occupational skin cancer resulting from exposure to solar UV radiation, and is by far the world’s most common cancer, with 2-3 million cases diagnosed annually.

In the European Union, more than 14.5 million workers are regularly exposed to solar UV radiation for more than 75% of their daily working hours. Occupational skin diseases, which also includes contact dermatitis, are estimated to lead to costs far beyond €5 billion annually in the EU alone. However, a lack of reporting and accurate data has allowed this crisis to remain in the shadows.

Here, Health Europa speaks to Dr. Swen Malte John, Chair of the European Academy of Dermatology and Venereology (EADV) Task Force on occupational skin disease, who highlights the importance of raising awareness regarding non-melanoma skin cancer and bringing occupational skin cancer out of the shadows.

Non-melanoma skin cancer is the world’s most common cancer, why do you believe it is kept in the shadows?

Occupational non-melanoma skin cancer is kept in the shadows due to the fact that there is very limited reporting regarding these diseases so far. Cases happen, and they happen very frequently, and in those countries where they are reported we get an estimation of the magnitude of the disease burden, and also if we screen workers’ cohorts we can identify how many of these outdoor workers do have skin cancer, but they are not officially reported and for that reason they do not appear in official statistics. Therefore, politicians say, there is not a problem.

For instance, in Germany where occupational skin cancer is reported quite accurately, we can say it is already the 2nd most frequent occupational disease and by far the most frequent occupational cancer (30,000 notified cases since 2015; 8,557 alone in 2017; and figures are further rising).

The problem that many workers face is that usually if they have been exposed to the sun throughout their working life, a substantial amount of sun damage to the skin (we call it a actinic damage) is acquired. Thus, if skin cancer occurs in such an area of the body it is quite likely to appear shortly after in an adjacent area. Skin cancer in outdoor workers is essentially a highly chronic disease. And we see many workers who were unaware of such risks, especially male workers with long-term exposure to the sun, that now have to see their dermatologist for treatment every fortnight. They ask: “Why hasn’t anybody ever told me before? I would definitely have taken protection!”

What should people know about NMSC? What are the signs and symptoms and how can they lower their risk?

Most people, when thinking of skin cancer, think of something black or dark, this is true but this form of skin cancer, known as malignant melanoma, is comparatively rare, but what we’re talking about is extremely frequent and is skin coloured.

Non-melanoma skin cancer is characterised as little skin coloured knobs, or where areas of the skin become rough and scaly, with the patients initially feeling more than what they can see. The lesions typically occur on the exterior part of the body that are exposed most to the sun (“sun terraces”), for example, the top of the head, nose, cheeks, the lower lip, the back of the hands and the extensors surfaces of the forearms.

Protection is so easy and simple. In the priority list of prevention organisational aspects come first.

For example, from 11am-3pm it is 85% of the daily UV exposure, so in these hours it could be advised to not spend lunch break outside; maybe even have split work with a break in the middle of the day. By doing so, workers drastically reduce UV exposure. Also, sun shields at worksites are a simple measure of protection, which also protect against heat stroke. The second-best thing is to wear clothing and a brimmed hat with neck protection. The last line is to use high SPF sunscreens (50+) is in those skin areas which are not covered.

What would you like to see the EU do to protect workers at risk of developing non-melanoma skin cancer?

The main thing is information. There are so many publications now from various countries where they explored how workers did protect themselves from UV radiation and what is their knowledge.

The outcome is that there’s a tremendous lack of both; outdoor workers are predominantly male, and sun smart behaviour doesn’t seem something that comes easily to their minds. The findings support the stigma of men not taking much interest in their health, which is essentially contributing to the reason as to why more detailed knowledge regarding the condition is extremely limited.

So, I believe with more information being shared regarding NMSC, workers and employers would be empowered to understand the dangers, and the best ways to protection.

However, this will only be achieved with improved legal regulations, regular screening and consultation of these high-risk populations and the provision of sun protection at the workplaces by the employers.

What do you hope to achieve with the White Paper and Global Call-to-Action that is being presented at this Multi-Stakeholder Summit on Occupational Skin Cancer?

There are a number of things that need change and the first thing is awareness. The necessity is to ensure that cases are being reported, so policy makers know that there is the problem. That would enable a work protection directive on solar optical radiation and that skin cancer by solar UV is entered in the EU Recommendation of Occupational Diseases, which then has to be implemented in national law in the member states.

Improved sun-smart behaviour in work places is necessary from early on, such as workers being better equipped with what is needed, from protective clothing to sunscreens. Employers have to be legally obliged to do that. Moreover, if skin cancer occurs in outdoor workers, there should be early medical treatment and compensation.

Anyone who has been in a career based outdoors longer than 5 years is at high risk for non-melanoma skin cancer, and for that reason there should be regular screening.

Furthermore, by that you will detect so many workers at an early stage of the condition and action can be taken immediately to ensure the disease does not get worse, and that option to improve workers’ health is completely missed at the moment.

The WHO and UN’s commitment to addressing non-melanoma skin cancer

The WHO and the international labour organisation (ILO) are UN institutions, who are committed to the UN sustainable development goals 2030. This is an approach by the UN to make the world a better place, and within this they have now focused on the effect of work on health as one of their top priorities.

Within the occupational illnesses, WHO and ILO identified occupational skin cancer as one of 10 priority topics as they know that this is a neglected, however serious problem that needs to be tackled and is highly responsive to efficient prevention.


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