Alexandra-Irina Butacu1, Marc Wittlich2, Swen Malte John3, Sabina Zurac4, Mihai Dascalu5, Horatiu Moldovan6, George-Sorin Tiplica7. 1. Dermatology Reseach Unit, Colentina Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania. 2. Institute for Occupational Safety and Health of the German Social Accident Insurance, Sankt Augustin, Germany. 3. Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany. 4. Department of Pathology, Colentina Clinical Hospital, Bucharest, Romania. 5. "Politehnica" University, Faculty of Automatic Control and Computers, Bucharest, Romania. 6. University of Medicine, Pharmacy, Science & Technology of Targu-Mures, Department of Occupational Medicine, Targu Mures, Romania. 7. 2nd Department of Dermatology, Colentina Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
Abstract
Background: Non-melanoma skin cancer (NMSC) represents the most frequently diagnosed cancer in humans. Occupational solar UV radiation exposure is associated with a higher-risk of developing NMSC, but still Romania does not acknowledge this affliction as an occupational disease. The study aims to determine if occupationally-induced NMSC is associated with more aggressive clinical and histopathological features compared to sporadic NMSC. Material and methods: A retrospective, analytical, comparative study was conducted during 2017-2019 in a University Department of Dermato-venereology in Bucharest, Romania, with focus on patients presenting with NMSC who underwent surgical excision of lesions followed by histopathological examination, classified as outdoor or indoor workers. High-risk clinical and histopathological characteristics were analysed and correlated with outdoor UV exposure. Outcomes: The study included 51 consecutive patients diagnosed with NMSC, of which 25 outdoor workers (OW) and 26 controls as indoor workers with no occupational UV exposure background. OW presented with 21 BCC and four SCC, while controls with 22 BCC and four SCC. Males were predominant in both groups and most patients came from urban environment. The mean age value was lower for the OW group compared to controls. OW had a 4.66 times higher risk of developing NMSC with aggressive location and size χ² (1, N=51) = 6.246, p=0.013, OR=4.66 (95% CI: 1.34, 16.23) and a 24-fold risk of developing NMSC with clinically poorly defined margins χ² (1, N=51) = 21.697, p<0.001, OR=24.44 (95% CI: 5.38,110.92). The risk of developing a high-risk histopathological subtype was 15 times greater for OW χ² (1, N=51) = 13.814, p<0.001, OR=15.27 (95% CI: 2.94,79.08). Moderate to severe desmoplastic reaction was 8.57 more frequent in controls χ² (1, N=51) = 12.244, p=0.001, OR=8.57 (95% CI: 2.42, 30.30). Grades 2 and 3 of actinic elastosis were significantly associated with outdoor work (χ² (1, N=51) = 33.382, p<0.001, OR=131.25 (95% CI: 13.60, 1266.37). The presence of ulceration and pigment association of tumors on the histopathological report were not significantly associated with outdoor working. Conclusion: 1. Occupational NMSC in Romania is associated with high-risk clinical features; 2. Poorly defined borders is a significant clinical high-risk factor associated with occupational UV exposure in NMSC; 3. High-risk histopathological subtypes are more frequently encountered in outdoor workers diagnosed with NMSC compared to indoor workers with no occupational UV exposure background; 4. Occupational NMSC is associated with significantly higher grades of desmoplastic reaction and of actinic elastosis compared to indoor workers.
Background: Non-melanoma skin cancer (NMSC) represents the most frequently diagnosed cancer in humans. Occupational solar UV radiation exposure is associated with a higher-risk of developing NMSC, but still Romania does not acknowledge this affliction as an occupational disease. The study aims to determine if occupationally-induced NMSC is associated with more aggressive clinical and histopathological features compared to sporadic NMSC. Material and methods: A retrospective, analytical, comparative study was conducted during 2017-2019 in a University Department of Dermato-venereology in Bucharest, Romania, with focus on patients presenting with NMSC who underwent surgical excision of lesions followed by histopathological examination, classified as outdoor or indoor workers. High-risk clinical and histopathological characteristics were analysed and correlated with outdoor UV exposure. Outcomes: The study included 51 consecutive patients diagnosed with NMSC, of which 25 outdoor workers (OW) and 26 controls as indoor workers with no occupational UV exposure background. OW presented with 21 BCC and four SCC, while controls with 22 BCC and four SCC. Males were predominant in both groups and most patients came from urban environment. The mean age value was lower for the OW group compared to controls. OW had a 4.66 times higher risk of developing NMSC with aggressive location and size χ² (1, N=51) = 6.246, p=0.013, OR=4.66 (95% CI: 1.34, 16.23) and a 24-fold risk of developing NMSC with clinically poorly defined margins χ² (1, N=51) = 21.697, p<0.001, OR=24.44 (95% CI: 5.38,110.92). The risk of developing a high-risk histopathological subtype was 15 times greater for OW χ² (1, N=51) = 13.814, p<0.001, OR=15.27 (95% CI: 2.94,79.08). Moderate to severe desmoplastic reaction was 8.57 more frequent in controls χ² (1, N=51) = 12.244, p=0.001, OR=8.57 (95% CI: 2.42, 30.30). Grades 2 and 3 of actinic elastosis were significantly associated with outdoor work (χ² (1, N=51) = 33.382, p<0.001, OR=131.25 (95% CI: 13.60, 1266.37). The presence of ulceration and pigment association of tumors on the histopathological report were not significantly associated with outdoor working. Conclusion: 1. Occupational NMSC in Romania is associated with high-risk clinical features; 2. Poorly defined borders is a significant clinical high-risk factor associated with occupational UV exposure in NMSC; 3. High-risk histopathological subtypes are more frequently encountered in outdoor workers diagnosed with NMSC compared to indoor workers with no occupational UV exposure background; 4. Occupational NMSC is associated with significantly higher grades of desmoplastic reaction and of actinic elastosis compared to indoor workers.
Authors: H R Moldovan; S T Voidazan; S M John; P Weinert; G Moldovan; M A Vlasiu; Z A Szasz; G S Tiplica; S Szasz; A C Marin; C M Salavastru Journal: J Eur Acad Dermatol Venereol Date: 2017-06 Impact factor: 6.166
Authors: Martin P Gallagher; Patrick J Kelly; Meg Jardine; Vlado Perkovic; Alan Cass; Jonathan C Craig; Josette Eris; Angela C Webster Journal: J Am Soc Nephrol Date: 2010-04-29 Impact factor: 10.121
Authors: Jochen Schmitt; Eva Haufe; Freya Trautmann; Hans-Joachim Schulze; Peter Elsner; Hans Drexler; Andrea Bauer; Stephan Letzel; Swen Malte John; Manigé Fartasch; Thomas Brüning; Andreas Seidler; Susanne Dugas-Breit; Michal Gina; Wobbeke Weistenhöfer; Klaus Bachmann; Ilka Bruhn; Berenice Mareen Lang; Sonja Bonness; Jean Pierre Allam; William Grobe; Thoralf Stange; Stephan Westerhausen; Peter Knuschke; Marc Wittlich; Thomas Ludwig Diepgen Journal: J Occup Environ Med Date: 2018-01 Impact factor: 2.162
Authors: Kay D Brantsch; Christoph Meisner; Birgitt Schönfisch; Birgit Trilling; Jörg Wehner-Caroli; Martin Röcken; Helmut Breuninger Journal: Lancet Oncol Date: 2008-07-09 Impact factor: 41.316
Authors: John Y S Kim; Jeffrey H Kozlow; Bharat Mittal; Jeffrey Moyer; Thomas Olenecki; Phillip Rodgers Journal: J Am Acad Dermatol Date: 2018-01-10 Impact factor: 11.527