J Korean Med Sci.  2024 Nov;39(42):e316. 10.3346/jkms.2024.39.e316.

Occupational Risk Factors for Skin Cancer: A Comprehensive Review

Affiliations
  • 1Department of Occupational and Environmental Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
  • 2Department of Public Health, Graduate School, The Catholic University of Korea, Seoul, Korea
  • 3Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
  • 4Department of Dermatology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

Abstract

Public health and clinical medicine should identify and characterize modifiable risk factors for skin cancer in order to facilitate primary prevention. In existing literature, the impact of occupational exposure on skin cancer, including malignant melanoma and nonmelanoma skin cancers, has been extensively studied. This review summarizes the available epidemiological evidence on the significance of occupational risk factors and occupations associated with a higher risk in skin cancer. The results of this review suggest that there is sufficient epidemiological evidence to support the relationship between the increased risk of non-melanoma skin cancers and occupational exposure to solar radiation, ultraviolet radiation, ionizing radiation, arsenic and its compounds, and mineral oils. Occupational exposure to pesticides and polychlorinated biphenyls appears to provide sufficient epidemiological evidence for melanoma, and a higher risk of melanoma has been reported among workers in petroleum refining and firefighters. This comprehensive analysis will establish a foundation for subsequent investigations and developing targeted interventions of focused preventive measures against skin cancer among the working population.

Keyword

Skin Neoplasms; Melanoma; Risk Factors; Occupational Exposure; Occupations; Radiation

Figure

  • Fig. 1 Schematic diagram summarizing the possible occupational risk factors for skin cancer.NMSC = non-melanoma skin cancer, MM = malignant melanoma.


Reference

1. Linares MA, Zakaria A, Nizran P. Skin cancer. Prim Care. 2015; 42(4):645–659. PMID: 26612377.
2. Achatz MI, Coloma MC, de Albuquerque Cavalcanti Callegaro E. Risk factors for skin cancer. Abdalla CMZ, Sanches JA, Munhoz RR, Belfort FA, editors. Oncodermatology. Cham, Switzerland: Springer;2023. p. 37–55.
3. Song HS, Ryou HC. Compensation for occupational skin diseases. J Korean Med Sci. 2014; 29(Suppl):S52–S58. PMID: 25006325.
4. World Meteorological Organization. Global Ozone Research and Monitoring Project. Scientific Assessment of Ozone Depletion: 2006, Report 50. Geneva, Switzerland: World Meteorological Organization;2007.
5. Young AR. Chapter 1: Damage from acute vs chronic solar exposure. Giacomoni PU, Jori G, Hader DP, editors. Biophysical and Physiological Effects of Solar Radiation on Human Skin. Cambridge, UK: RSC Publishing;2007.
6. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Solar and Ultraviolet Radiation. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans Volume 55. Lyon, France: International Agency for Research on Cancer;1992.
7. World Health Organization. The Effect of Occupational Exposure to Solar Ultraviolet Radiation on Malignant Skin Melanoma and Nonmelanoma Skin Cancer: A Systematic Review and Meta-analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury. Geneva, Switzerland: World Health Organization;2021.
8. Jin HR, Lee JY, Lee DW, Shin SO, Choi YS, Yoo SJ, et al. Primary facial skin cancer: clinical characteristics and surgical outcome in Chungbuk Province, Korea. J Korean Med Sci. 2005; 20(2):279–282. PMID: 15832001.
9. Loney T, Paulo MS, Modenese A, Gobba F, Tenkate T, Whiteman DC, et al. Global evidence on occupational sun exposure and keratinocyte cancers: a systematic review. Br J Dermatol. 2021; 184(2):208–218. PMID: 32320481.
10. Zink A, Tizek L, Schielein M, Böhner A, Biedermann T, Wildner M. Different outdoor professions have different risks - a cross-sectional study comparing non-melanoma skin cancer risk among farmers, gardeners and mountain guides. J Eur Acad Dermatol Venereol. 2018; 32(10):1695–1701. PMID: 29806193.
11. Trakatelli M, Barkitzi K, Apap C, Majewski S, De Vries E. EPIDERM group. Skin cancer risk in outdoor workers: a European multicenter case-control study. J Eur Acad Dermatol Venereol. 2016; 30(Suppl 3):5–11.
12. Radespiel-Tröger M, Meyer M, Pfahlberg A, Lausen B, Uter W, Gefeller O. Outdoor work and skin cancer incidence: a registry-based study in Bavaria. Int Arch Occup Environ Health. 2009; 82(3):357–363. PMID: 18649084.
13. Hassel JC, Enk AH. Melanoma etiology and pathogenesis. Kang S, Amagai M, Bruckner AL, Enk AH, Margolis DJ, McMichael AJ, editors. Fitzpatrick's Dermatology in General Medicine. 9th ed. New York, NY, USA: McGraw-Hill Education;2019. p. 1989–1991.
14. Collatuzzo G, Boffetta P, Dika E, Visci G, Zunarelli C, Mastroeni S, et al. Occupational exposure to arsenic, mercury and UV radiation and risk of melanoma: a case-control study from Italy. Int Arch Occup Environ Health. 2023; 96(3):443–449. PMID: 36378322.
15. Gilbert ES. Ionising radiation and cancer risks: what have we learned from epidemiology? Int J Radiat Biol. 2009; 85(6):467–482. PMID: 19401906.
16. Ron E, Modan B, Preston D, Alfandary E, Stovall M, Boice JD Jr. Radiation-induced skin carcinomas of the head and neck. Radiat Res. 1991; 125(3):318–325. PMID: 2000456.
17. Shore RE, Albert RE, Reed M, Harley N, Pasternack BS. Skin cancer incidence among children irradiated for ringworm of the scalp. Radiat Res. 1984; 100(1):192–204. PMID: 6494429.
18. Thompson DE, Mabuchi K, Ron E, Soda M, Tokunaga M, Ochikubo S, et al. Cancer incidence in atomic bomb survivors. Part II: Solid tumors, 1958-1987. Radiat Res. 1994; 137(2):Suppl. S17–S67. PMID: 8127952.
19. Cuperus E, Leguit R, Albregts M, Toonstra J. Post radiation skin tumors: basal cell carcinomas, squamous cell carcinomas and angiosarcomas. A review of this late effect of radiotherapy. Eur J Dermatol. 2013; 23(6):749–757. PMID: 24153098.
20. Bennardo L, Passante M, Cameli N, Cristaudo A, Patruno C, Nisticò SP, et al. Skin manifestations after ionizing radiation exposure: a systematic review. Bioengineering (Basel). 2021; 8(11):153. PMID: 34821719.
21. Azizova TV, Bannikova MV, Grigoryeva ES, Rybkina VL. Risk of malignant skin neoplasms in a cohort of workers occupationally exposed to ionizing radiation at low dose rates. PLoS One. 2018; 13(10):e0205060. PMID: 30289933.
22. Azizova TV, Bannikova MV, Grigoryeva ES, Rybkina VL. Risk of skin cancer by histological type in a cohort of workers chronically exposed to ionizing radiation. Radiat Environ Biophys. 2021; 60(1):9–22. PMID: 33389049.
23. Yoshinaga S, Hauptmann M, Sigurdson AJ, Doody MM, Freedman DM, Alexander BH, et al. Nonmelanoma skin cancer in relation to ionizing radiation exposure among U.S. radiologic technologists. Int J Cancer. 2005; 115(5):828–834. PMID: 15704092.
24. Lee T, Sigurdson AJ, Preston DL, Cahoon EK, Freedman DM, Simon SL, et al. Occupational ionising radiation and risk of basal cell carcinoma in US radiologic technologists (1983-2005). Occup Environ Med. 2015; 72(12):862–869. PMID: 26350677.
25. Fink CA, Bates MN. Melanoma and ionizing radiation: is there a causal relationship? Radiat Res. 2005; 164(5):701–710. PMID: 16238450.
26. Freedman DM, Sigurdson A, Rao RS, Hauptmann M, Alexander B, Mohan A, et al. Risk of melanoma among radiologic technologists in the United States. Int J Cancer. 2003; 103(4):556–562. PMID: 12478675.
27. Gawkrodger DJ. Occupational skin cancers. Occup Med (Lond). 2004; 54(7):458–463. PMID: 15486177.
28. Sanlorenzo M, Wehner MR, Linos E, Kornak J, Kainz W, Posch C, et al. The risk of melanoma in airline pilots and cabin crew: a meta-analysis. JAMA Dermatol. 2015; 151(1):51–58. PMID: 25188246.
29. Martínez-Castillo M, García-Montalvo EA, Arellano-Mendoza MG, Sánchez-Peña LD, Soria Jasso LE, Izquierdo-Vega JA, et al. Arsenic exposure and non-carcinogenic health effects. Hum Exp Toxicol. 2021; 40(12_suppl):S826–S850. PMID: 34610256.
30. Chung JY, Yu SD, Hong YS. Environmental source of arsenic exposure. J Prev Med Public Health. 2014; 47(5):253–257. PMID: 25284196.
31. Hunt KM, Srivastava RK, Elmets CA, Athar M. The mechanistic basis of arsenicosis: pathogenesis of skin cancer. Cancer Lett. 2014; 354(2):211–219. PMID: 25173797.
32. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Arsenic and arsenic compounds. Arsenic, Metals, Fibres and Dusts. Lyon, France: International Agency for Research on Cancer;2012.
33. Yu HS, Liao WT, Chai CY. Arsenic carcinogenesis in the skin. J Biomed Sci. 2006; 13(5):657–666. PMID: 16807664.
34. Smith AH, Goycolea M, Haque R, Biggs ML. Marked increase in bladder and lung cancer mortality in a region of Northern Chile due to arsenic in drinking water. Am J Epidemiol. 1998; 147(7):660–669. PMID: 9554605.
35. Kim TH, Seo JW, Hong YS, Song KH. Case-control study of chronic low-level exposure of inorganic arsenic species and non-melanoma skin cancer. J Dermatol. 2017; 44(12):1374–1379. PMID: 28815697.
36. Surdu S, Fitzgerald EF, Bloom MS, Boscoe FP, Carpenter DO, Haase RF, et al. Occupational exposure to arsenic and risk of nonmelanoma skin cancer in a multinational European study. Int J Cancer. 2013; 133(9):2182–2191. PMID: 23595521.
37. Karagas MR, Stukel TA, Morris JS, Tosteson TD, Weiss JE, Spencer SK, et al. Skin cancer risk in relation to toenail arsenic concentrations in a US population-based case-control study. Am J Epidemiol. 2001; 153(6):559–565. PMID: 11257063.
38. Dennis LK, Lynch CF, Sandler DP, Alavanja MC. Pesticide use and cutaneous melanoma in pesticide applicators in the agricultural heath study. Environ Health Perspect. 2010; 118(6):812–817. PMID: 20164001.
39. Bedaiwi A, Wysong A, Rogan EG, Clarey D, Arcari CM. Arsenic exposure and melanoma among US adults aged 20 or older, 2003-2016. Public Health Rep. 2022; 137(3):548–556. PMID: 33971104.
40. Langston ME, Brown HE, Lynch CF, Roe DJ, Dennis LK. Ambient UVR and environmental arsenic exposure in relation to cutaneous melanoma in Iowa. Int J Environ Res Public Health. 2022; 19(3):1742. PMID: 35162766.
41. Kim KH, Kabir E, Jahan SA. Exposure to pesticides and the associated human health effects. Sci Total Environ. 2017; 575:525–535. PMID: 27614863.
42. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Occupational exposures in insecticide application, and some pesticides. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Lyon, 16-23 October 1990. IARC Monogr Eval Carcinog Risks Hum. 1991; 53:5–586. PMID: 1688189.
43. International Agency for Research on Cancer (IARC). List of classifications by cancer sites with sufficient or limited evidence in humans, IARC Monographs Volumes 1-135. Accessed January 30, 2024. https://monographs.iarc.who.int/wp-content/uploads/2019/07/Classifications_by_cancer_site.pdf .
44. Frost G, Brown T, Harding AH. Mortality and cancer incidence among British agricultural pesticide users. Occup Med (Lond). 2011; 61(5):303–310. PMID: 21709170.
45. Stanganelli I, De Felici MB, Mandel VD, Caini S, Raimondi S, Corso F, et al. The association between pesticide use and cutaneous melanoma: a systematic review and meta-analysis. J Eur Acad Dermatol Venereol. 2020; 34(4):691–708. PMID: 31541557.
46. Varghese JV, Sebastian EM, Iqbal T, Tom AA. Pesticide applicators and cancer: a systematic review. Rev Environ Health. 2020; 36(4):467–476. PMID: 34821114.
47. de Graaf L, Boulanger M, Bureau M, Bouvier G, Meryet-Figuiere M, Tual S, et al. Occupational pesticide exposure, cancer and chronic neurological disorders: a systematic review of epidemiological studies in greenspace workers. Environ Res. 2022; 203:111822. PMID: 34352232.
48. Cavalier H, Trasande L, Porta M. Exposures to pesticides and risk of cancer: evaluation of recent epidemiological evidence in humans and paths forward. Int J Cancer. 2023; 152(5):879–912. PMID: 36134639.
49. Togawa K, Leon ME, Lebailly P, Beane Freeman LE, Nordby KC, Baldi I, et al. Cancer incidence in agricultural workers: findings from an International Consortium of Agricultural Cohort Studies (AGRICOH). Environ Int. 2021; 157:106825. PMID: 34461377.
50. Joshi DR, Adhikari N. An overview on common organic solvents and their toxicity. J Pharm Res Int. 2019; 28(3):1–18.
51. Lynge E, Anttila A, Hemminki K. Organic solvents and cancer. Cancer Causes Control. 1997; 8(3):406–419. PMID: 9498902.
52. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Polychlorinated biphenyls and polybrominated biphenyls. IARC Monogr Eval Carcinog Risks Hum. 2016; 107:9–500. PMID: 29905442.
53. Institute of Medicine. Gulf War and Health: Volume 2: Insecticides and Solvents. Washington, D.C., USA: The National Academies Press;2003.
54. Zani C, Ceretti E, Covolo L, Donato F. Do polychlorinated biphenyls cause cancer? A systematic review and meta-analysis of epidemiological studies on risk of cutaneous melanoma and non-Hodgkin lymphoma. Chemosphere. 2017; 183:97–106. PMID: 28535466.
55. Boffetta P, Catalani S, Tomasi C, Pira E, Apostoli P. Occupational exposure to polychlorinated biphenyls and risk of cutaneous melanoma: a meta-analysis. Eur J Cancer Prev. 2018; 27(1):62–69. PMID: 27749494.
56. Fritschi L, Siemiatycki J. Melanoma and occupation: results of a case-control study. Occup Environ Med. 1996; 53(3):168–173. PMID: 8704857.
57. Christensen KY, Vizcaya D, Richardson H, Lavoué J, Aronson K, Siemiatycki J. Risk of selected cancers due to occupational exposure to chlorinated solvents in a case-control study in Montreal. J Occup Environ Med. 2013; 55(2):198–208. PMID: 23147555.
58. Vujic I, Gandini S, Stanganelli I, Fierro MT, Rappersberger K, Sibilia M, et al. A meta-analysis of melanoma risk in industrial workers. Melanoma Res. 2020; 30(3):286–296. PMID: 30371537.
59. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Chemical agents and related occupations. IARC Monogr Eval Carcinog Risks Hum. 2012; 100(Pt F):9–562. PMID: 23189753.
60. Costello S, Friesen MC, Christiani DC, Eisen EA. Metalworking fluids and malignant melanoma in autoworkers. Epidemiology. 2011; 22(1):90–97. PMID: 20975563.
61. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Polynuclear aromatic hydrocarbons, Part 2, Carbon blacks, mineral oils (lubricant base oils and derived products) and some nitroarenes. IARC Monogr Eval Carcinog Risk Chem Hum. 1984; 33:1–222. PMID: 6590450.
62. National Institute for Occupational Safety and Health. What You Need to Know about Occupational Exposure to Metalworking Fluids. Washington, D.C., USA: Department of Health and Human Services;1998.
63. Costello S, Chen K, Picciotto S, Lutzker L, Eisen E. Metalworking fluids and cancer mortality in a US autoworker cohort (1941-2015). Scand J Work Environ Health. 2020; 46(5):525–532. PMID: 32406514.
64. Zhao Y, Krishnadasan A, Kennedy N, Morgenstern H, Ritz B. Estimated effects of solvents and mineral oils on cancer incidence and mortality in a cohort of aerospace workers. Am J Ind Med. 2005; 48(4):249–258. PMID: 16167347.
65. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Occupational exposures in petroleum refining; crude oil and major petroleum fuels. IARC Monogr Eval Carcinog Risks Hum. 1989; 45:1–322. PMID: 2664246.
66. Lee WJ, Lewis SJ, Chen YY, Wang YF, Sheu HL, Su CC, et al. Polychlorinated biphenyls in the ambient air of petroleum refinery, urban and rural areas. Atmos Environ. 1996; 30(13):2371–2378.
67. Davis BF. Paraffin cancer: CCAL and petroleum products as cause of chronic irritation and cancer. J Am Med Assoc. 1914; 62(22):1716–1720.
68. Lione JG, Denholm JS. Cancer of the scrotum in wax pressmen. II. Clinical observations. AMA Arch Ind Health. 1959; 19(5):530–539. PMID: 13636468.
69. Gun RT, Pratt N, Ryan P, Roder D. Update of mortality and cancer incidence in the Australian petroleum industry cohort. Occup Environ Med. 2006; 63(7):476–481. PMID: 16698808.
70. Wojcik NC, Gallagher EM, Alexander MS, Lewis RJ. Mortality of 196,826 men and women working in U.S.-based petrochemical and refinery operations: update 1979 to 2010. J Occup Environ Med. 2022; 64(3):250–262. PMID: 34670258.
71. Sorahan T. Mortality of UK oil refinery and petroleum distribution workers, 1951-2003. Occup Med (Lond). 2007; 57(3):177–185. PMID: 17244595.
72. Schnatter AR, Chen M, DeVilbiss EA, Lewis RJ, Gallagher EM. Systematic review and meta-analysis of selected cancers in petroleum refinery workers. J Occup Environ Med. 2018; 60(7):e329–e342. PMID: 29985303.
73. Onyije FM, Hosseini B, Togawa K, Schüz J, Olsson A. Cancer incidence and mortality among petroleum industry workers and residents living in oil producing communities: a systematic review and meta-analysis. Int J Environ Res Public Health. 2021; 18(8):4343. PMID: 33923944.
74. Mehlman MA. Causal relationship from exposure to chemicals in oil refining and chemical industries and malignant melanoma. Ann N Y Acad Sci. 2006; 1076(1):822–828. PMID: 17119259.
75. IARC Working Group on the Identification of Carcinogenic Hazards to Humans. Occupational Exposure as a Firefighter. Lyon, France: International Agency for Research on Cancer;2023.
76. Casjens S, Brüning T, Taeger D. Cancer risks of firefighters: a systematic review and meta-analysis of secular trends and region-specific differences. Int Arch Occup Environ Health. 2020; 93(7):839–852. PMID: 32306177.
77. Bigert C, Martinsen JI, Gustavsson P, Sparén P. Cancer incidence among Swedish firefighters: an extended follow-up of the NOCCA study. Int Arch Occup Environ Health. 2020; 93(2):197–204. PMID: 31463517.
78. Lee DJ, Ahn S, McClure LA, Caban-Martinez AJ, Kobetz EN, Ukani H, et al. Cancer risk and mortality among firefighters: a meta-analytic review. Front Oncol. 2023; 13:1130754. PMID: 37251928.
79. Jalilian H, Ziaei M, Weiderpass E, Rueegg CS, Khosravi Y, Kjaerheim K. Cancer incidence and mortality among firefighters. Int J Cancer. 2019; 145(10):2639–2646. PMID: 30737784.
80. Pukkala E, Martinsen JI, Weiderpass E, Kjaerheim K, Lynge E, Tryggvadottir L, et al. Cancer incidence among firefighters: 45 years of follow-up in five Nordic countries. Occup Environ Med. 2014; 71(6):398–404. PMID: 24510539.
81. Kullberg C, Andersson T, Gustavsson P, Selander J, Tornling G, Gustavsson A, et al. Cancer incidence in Stockholm firefighters 1958-2012: an updated cohort study. Int Arch Occup Environ Health. 2018; 91(3):285–291. PMID: 29164319.
82. Sidossis A, Lan FY, Hershey MS, Hadkhale K, Kales SN. Cancer and potential prevention with lifestyle among career firefighters: a narrative review. Cancers (Basel). 2023; 15(9):2442. PMID: 37173909.
83. Miller BG, Cowie HA, Middleton WG, Seaton A. Epidemiologic studies of Scottish oil shale workers: III. Causes of death. Am J Ind Med. 1986; 9(5):433–446. PMID: 3717168.
84. Costello CM, Pittelkow MR, Mangold AR. Acral melanoma and mechanical stress on the plantar surface of the foot. N Engl J Med. 2017; 377(4):395–396. PMID: 28745985.
85. Fortes C, Mastroeni S, Segatto M M, Hohmann C, Miligi L, Bakos L, et al. Occupational exposure to pesticides with occupational sun exposure increases the risk for cutaneous melanoma. J Occup Environ Med. 2016; 58(4):370–375. PMID: 27058477.
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