Ulrich C, Salavastru C, Agner T, Bauer A, Brans R, Crepy M N, Ettler K, Gobba F, Goncalo M, Imko-Walczuk B, Lear J, Macan J, Modenese A, Paoli J, Sartorelli P, Stageland K, Weinert P, Wroblewski N, Wulf H C, John S M
Department of Dermatology, Skin Cancer Centre, Charité Universitätsmedizin Berlin, Berlin, Germany.
Dermato-oncology Research Unit, Colentina Clinical Hospital, and Dermato-oncology Research Unit, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
J Eur Acad Dermatol Venereol. 2016 Apr;30 Suppl 3:46-51. doi: 10.1111/jdv.13609.
Skin cancer is the most common malignancy in Caucasian populations worldwide and ultraviolet radiation (UVR) is known for being the number one carcinogen. As, especially in outdoor workers, UVR is an inevitable carcinogen, the prevention and management of UVR-related skin cancers in these at-risk populations represent a collective challenge for dermatologists and healthcare policymakers likewise.
To provide an overview on the current regulations on the acknowledgement and management of work-related skin cancer in 11 European countries.
Dermatologists from 11 countries networking within the EU Horizon 2020 COST Action TD1206 'StanDerm' contributed to a standardized survey regarding current national regulations, implemented for the recognition, prevention and management as well as possible compensation regulations in their individual country of residence.
Ten of 11 participating countries in this survey reported the existence of an established programme available on certain occupational diseases; work-related skin diseases were only specifically recognized in eight countries. Seven of 11 countries recognize cutaneous squamous cell carcinoma in outdoor workers as 'occupational skin cancer'. Basal cell carcinoma (6 of 11), actinic keratosis (5 of 11), Bowen's disease (5 of 11) and malignant melanoma (5 of 11) are not as regularly approved as potentially 'work-induced'. Only a few of the countries included into this survey established a general documentation system (national registry) on occupational skin diseases. So far, representatives of only three countries of this survey referred to a specific established national programme for the prevention, management or compensation of occupational skin cancers acquired during work-related UVR exposure.
This survey highlights the need for mandatory regulations on the prevention, management and potential compensation of work-related UV-induced skin cancer across Europe. Against the background of a joint European domestic market, equal standards of occupational safety across Europe should include binding regulations for the protection and management of work-related skin cancer. The design of a common regulation to meet the increasing incidence of skin cancers in outdoor workers should become part of the European agenda, ensuring equal working and living conditions in the member states.
皮肤癌是全球白种人群中最常见的恶性肿瘤,紫外线辐射(UVR)是头号致癌物。尤其是在户外工作者中,UVR是不可避免的致癌物,因此,在这些高危人群中预防和管理与UVR相关的皮肤癌,对皮肤科医生和医疗政策制定者而言都是一项共同挑战。
概述11个欧洲国家目前关于职业性皮肤癌认定和管理的法规。
来自11个国家的皮肤科医生参与了欧盟地平线2020科研与创新框架计划成本行动TD1206“标准皮肤学”,他们参与了一项标准化调查,内容涉及各自居住国现行的国家法规,这些法规用于职业性皮肤癌的认定、预防、管理以及可能的赔偿规定。
参与此次调查的11个国家中有10个报告称存在关于某些职业病的既定项目;只有8个国家专门认可了职业性皮肤病。11个国家中有7个将户外工作者的皮肤鳞状细胞癌认定为“职业性皮肤癌”。基底细胞癌(11个国家中的6个)、光化性角化病(11个国家中的5个)、鲍恩病(11个国家中的5个)和恶性黑色素瘤(11个国家中的5个)作为可能“工作诱发”的疾病,其认定情况并不那么普遍。参与此次调查的国家中只有少数几个建立了职业性皮肤病的通用文档系统(国家登记处)。到目前为止,参与此次调查的国家中只有三个国家的代表提到了一个既定的国家特定项目,用于预防、管理或赔偿与工作相关的UVR暴露导致的职业性皮肤癌。
本次调查凸显了欧洲各地对与工作相关的紫外线诱发皮肤癌的预防、管理和潜在赔偿制定强制性法规的必要性。在欧洲共同国内市场的背景下,全欧洲统一的职业安全标准应包括保护和管理与工作相关皮肤癌的具有约束力的法规。制定一项共同法规以应对户外工作者中皮肤癌发病率不断上升的情况,应成为欧洲议程的一部分,确保成员国的工作和生活条件平等。