Modonese Alberto, Gobba Fabriziomaria
Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze, Università degli Studi di Modena e Reggio Emilia.
G Ital Med Lav Ergon. 2020 Dec;42(4):329-331.
Skin tumors are the most frequent neoplasms worldwide in Caucasian subjects, and UV exposure is one of the most relevant risk factors in their etiology. Cumulative UV exposure is strongly associated with an increased occurrence of both basal and squamous cell carcinomas (i.e. Non melanoma skin cancers - NMSC), while for malignant melanoma the role of UV radiation as risk factors seems more related to intermittent and intense exposures, able to induce repeated sunburns, at young ages. Considering the occupational risk, currently UV radiation, part of the solar radiation (SR) spectrum, is one of the major risks in all jobs including outdoor activities (outdoor work - OW): many studies show high levels of solar UV exposure during OW, nevertheless to date the European, and Italian, legislation on occupational risks prevention does not include specific requirements for SR compleexposure at work, as occupational exposure limits values or workers' health surveillance. This is not coherent with the strong associations showed in scientific literature in particular between the occurrence of NMSC and a history of OW. Accordingly, considering the high exposure levels, the large number of outdoor workers and the strong associations with NMSC, we'd expect a relevant number of occupational skin cancers (OSC) to be reported every year to the national workers' compensation authorities in European countries. Nevertheless, in Italy, as in other European countries, the number of reported UV-induced OSC is much lower than the expected number of OSC, with less than 40 cases reported on average in Italy in last years compared to about a thousand of expected cases incident in outdoor workers per year. An increasing in the reporting of OSC would certainly be important, for the purpose of a better recognition of the real dimension of the phenomenon, and to stimulate the implementation of adequate preventive strategies, in order to guarantee an improved protection of outdoor workers and a more appropriate prevention of the adverse health effects related to solar UV exposure.
皮肤肿瘤是全球白种人最常见的肿瘤，紫外线暴露是其病因中最相关的风险因素之一。紫外线累积暴露与基底细胞癌和鳞状细胞癌（即非黑色素瘤皮肤癌 - NMSC）发生率的增加密切相关，而对于恶性黑色素瘤，紫外线辐射作为风险因素的作用似乎更多地与年轻时的间歇性强烈暴露有关，这种暴露会导致反复晒伤。考虑到职业风险，目前紫外线辐射作为太阳辐射（SR）光谱的一部分，是包括户外活动（户外工作 - OW）在内的所有工作中的主要风险之一：许多研究表明户外工作期间太阳紫外线暴露水平很高，然而迄今为止，欧洲和意大利关于职业风险预防的立法并未包括对工作中太阳辐射综合暴露的具体要求，如职业接触限值或工人健康监测。这与科学文献中所显示的特别是NMSC的发生与户外工作史之间的强烈关联不一致。因此，考虑到高暴露水平、大量户外工作者以及与NMSC的强烈关联，我们预计每年会有相当数量的职业性皮肤癌（OSC）报告给欧洲国家的国家工人赔偿当局。然而，在意大利，与其他欧洲国家一样，报告的紫外线诱发的OSC数量远低于预期的OSC数量，过去几年意大利平均每年报告的病例不到40例，而每年户外工作者预计发生的病例约为1000例。增加OSC的报告对于更好地认识这一现象的实际规模以及刺激实施适当的预防策略肯定很重要，以便保证更好地保护户外工作者并更适当地预防与太阳紫外线暴露相关的不良健康影响。
