The number of skin cancer cases in men and women increases by 10% every year. Experts have drawn a correlation between this increase and the increased intensity of UV radiation in Germany. Skin cancer is already one of the most common forms of cancer. In Germany, around 260,000 people develop skin cancer each year, regardless of whether they have light or dark skin.
It became clear at the press conference from Spektrum Dermatologie 2022 that climate change is also causing an increase in terrestrial UV radiation, owing to special stratospheric conditions. So-called low-ozone events are more common. Because there are now many more cloud-free days than previously, the direct effect of UV radiation on the skin is increased. At the German Meteorological Service’s Hohenpeißenberg weather station in Bavaria, for quite some time now, UV levels on cloud-free days have been measured that previously would have only been recorded in Sicily.
Outdoor workers are exposed to particularly high levels of UV radiation and could be considered a high-risk group, underlined Swen Malte John, MD, PhD, from the Osnabrück University Hospital. Dosimetric measurements revealed unexpectedly high levels of UV exposure in outdoor professions, such as in the construction and agriculture sectors (>500 SED between April and October; 1 SED = 100 J/m²).
The epidemiologic data suggest that for outdoor workers, the risk of skin cancer in light skin (basal cell carcinoma and squamous cell carcinoma) is double that of the average population. This has led to UV-related skin cancer being recognized as an occupational disease. Skin cancer has been recognized as an occupational disease in Germany since 2015.
“We receive 10,000 reports of this every year, and 6000 cases have been recognized as an occupational disease. Unfortunately, this is already an alarmingly common disease, and climate change will not help things at all,” said John. Occupational skin cancer due to long-term sun exposure in outdoor workers is now the second-most common recognized occupational disease in Germany (6000 cases annually, around 800 of which involve significant pension claims). In Germany, the BG Hospital for Occupational Disease in Bad Reichenhall, Bavaria, offers rehabilitation stays for recognized occupational skin cancer.
UV Exposure Doubles
Whether or not one is exposed to increased levels of UV radiation in one’s line of work, a significantly higher level of exposure must be anticipated. In the past, the average person was exposed to 130 SED per year, but this rate has now doubled, according to John.
Skin cancer in light skin is now the most common form of cancer in men and women. “In the past, it was not so often that we would see someone with a UV-related skin tumor, especially not nonmelanoma skin cancer. But these days, we see it several times each day; in no way is it a rarity anymore, and it will only get worse. I’m worried about that,” said Max Tischler, MD, dermatologist in Dortmund.
According to John, a 10% annual increase in skin cancer cases should be expected, that is, double the number of cases in 10 years. This prediction takes the effects of climate change and demographic shifts into account (the risk of skin cancer in light skin increases with age).
Taking the number of cases into account, it is still unclear how medical care can be ensured for those affected in the coming years. “We have no idea how we are meant to care for these patients in the future,” said John. He stressed that physicians would have to resort to teledermatology to treat patients and that artificial intelligence or health apps would be needed to help with patient self-management.
No Healthy Tan
Sun protection is “absolutely crucial,” emphasized Tischler. It has been shown in Australia that continuity and consistency are hugely beneficial for prevention. Australia is the only country in the world with a light-skinned population in which the incidence of skin cancer is decreasing. In Germany, on the other hand, there is still a lot of catching up to do with regard to prevention. “Most people know that you should wear sunscreen, but many still do not do so,” reported Tischler. Many patients did not realize that they needed to put sunscreen on every day, especially during the summer, since the level of UV radiation can be high even when it is cloudy.
The correct amount of sunscreen is also important. Most people use too little. Many people still apparently believe in the “healthy tan.” “I was told this by my grandmother. But there is no such thing as a healthy tan. Tanning is the body’s first defensive reaction against excessive sun,” underlined Tischler, who also organizes daycare and kindergarten lessons about proper sun protection. The lessons are aimed not only at young children but also at teachers and parents.
Time and again, he learns that not enough sunscreen is being used or that the sunscreen’s sun protection factor was too low. It is not uncommon for him to be met with disbelieving stares as he tells a family that they should take half a liter of sunscreen with them for their summer beach holiday.
Treating Actinic Keratoses
Actinic keratosis is a photoinduced skin mutation and can be classified as an early form of squamous cell carcinoma. John has tried to encourage people to undergo regular skin cancer screenings. “The earlier that treatment is started, the more effective it is against actinic keratoses,” he said. Actinic keratosis has been recognized as an occupational disease since January 1, 2015. In 2008, the prevalence of the disease among 60- to 70-year-olds in Germany was 11.5%. In 2011, they accounted for 8.3% of the 100 most common outpatient dermatologic treatments in Germany.
In the S3 guidelines on actinic keratosis and the prevention of skin cancer, a lot of space is dedicated to occupational actinic skin damage. John explained that by recognizing occupational skin diseases, therapeutic procedures and guideline-based follow-up care that would not be possible through statutory health insurance can be provided at the expense of statutory accident insurance.
Currently, the number of people affected by actinic keratosis can only be estimated. “Definitely millions of people in Germany,” said John. Researchers in Hamburg reckon that there are up to 400,000 new cases every year, “but this is just speculation. We do not know exactly. We only know that it is an extremely large number,” said John.
Jens Malte Baron, MD, a dermatologist at the RWTH Aachen University, confirmed that the rate of actinic keratoses has increased. “We see patients every day at the outpatient dermatology clinic with actinic keratosis, and the number of patients increases every year.”
Baron explained that a wide range of treatments is available for actinic keratoses. They include ointment-based therapy, laser treatment, and a combination of laser and photodynamic therapy (PDT). PDT targets and destroys sick skin cells and simultaneously restores the surrounding healthy tissue.
Any tumor that penetrates less than 3 mm into the skin can be treated with PDT. “Which therapy is then suitable depends on whether the actinic keratosis has manifested in one or multiple locations, which locations, and how many of these there are. Even in difficult locations, such as around the eyelid, the use of lasers can be beneficial,” said Baron.
Experts regret that skin cancer screening could not be established at a European level as part of the European Union’s Beating Cancer Plan. Nevertheless, high-risk groups, such as outdoor workers, are now entitled to preventive care. As part of this occupational preventive care, employers must complete a risk assessment and provide clothing, sunglasses, and sunscreen. An occupational health consultation is also provided at the start of a career and every 3 years after that. In Germany, around seven million people are entitled to receive this occupational preventive care.
This article was translated from the Medscape German edition.