Skin Cancer Among Outdoor Workers

Occupational exposure to solar ultraviolet radiation is a recognized carcinogenic hazard and is particularly relevant for individuals who spend substantial portions of their working lives outdoors. Chronic cumulative exposure to sunlight may increase the risk of skin malignancies, especially keratinocyte cancers such as squamous-cell carcinoma and basal-cell carcinoma. The relationship between occupational sunlight exposure and melanoma is more complex and will therefore be evaluated separately when diagnostic information permits. This retrospective observational study will evaluate administrative and medical records of individuals with occupationally relevant skin cancer. The study will characterize the demographic, geographic, occupational, clinical, and disability-related features of affected workers. Available data will be used to examine age and sex distributions, geographic variation, diagnostic categories, patterns over time, and occupational characteristics associated with prolonged outdoor work and potential solar ultraviolet exposure. Skin cancers will be classified according to the diagnostic information available in the database. Where possible, basal-cell carcinoma, squamous-cell carcinoma, melanoma, and other malignant skin tumors will be evaluated separately because their epidemiology and relationship with ultraviolet radiation differ. Disability-related characteristics, including the type and degree of recognized impairment and whether disability determinations were temporary or permanent, will also be evaluated when available. Temporal trends will be examined to determine whether the number and proportion of occupational skin-cancer cases changed during the study period. Geographic and demographic differences will also be explored to identify groups with a higher burden of disease. Where appropriate denominators are available, rates will be calculated using the relevant working population as the population at risk. When appropriate population denominators are not available, results will be reported as distributions and proportions of claims rather than population incidence rates. Because skin cancer generally develops after cumulative ultraviolet exposure over many years, the study will not assume that the year in which a cancer was diagnosed or recognized represents the period during which the relevant occupational exposure occurred. Instead, occupational solar exposure will be considered a long-term cumulative exposure. The study is intended to improve understanding of the occupational burden of skin cancer among outdoor workers and to identify demographic, geographic, and occupational patterns that may be useful for prevention. Findings may contribute to improved occupational health strategies, including sun-protection policies, worker education, use of protective clothing and sunscreen, reduction of intense midday ultraviolet exposure when feasible, and targeted skin surveillance for workers with prolonged occupational exposure to sunlight.