By Ute Eppinger
Every year, skin cancers in men and women increase by 10%. In Germany, around 260,000 people are diagnosed with black or light skin cancer every year.
At the press conference «Spektrum Dermatologie 2022» it became clear that climate change also leads to an increase in terrestrial UV radiation due to special stratospheric constellations.So-called «low-ozone events» are more common. Due to the now numerous cloudless days, an increased direct UV effect on the skin takes place. At the measuring station at the Hoher Peißenberg of the German Weather Service, UV exposures have been measured for some time on cloudless days as previously only in Sicily.
External workers have a particularly high UV exposure and can be considered a high-risk group, emphasized Prof. Dr. Swen Malte John from the University Hospital Osnabrück. For example, dosimetric measurements have shown unexpectedly high UV exposures in outdoor occupations such as construction and agriculture (> 500 SED between April and October, 1 SED = 100 J/m²).
The epidemiological data suggest a doubling of the risk of non-melanoma skin cancer (basal cell carcinomas and squamous cell carcinomas) in external workers compared to the average population. This has led to the recognition of UV-induced skin cancer as an occupational disease. Since 2015, skin cancer has been recognized as an occupational disease in Germany.
«We have 10,000 reports every year and 6,000 cases are recognized as an occupational disease.Unfortunately, this is already a worryingly common disease and climate change is not making it any better,» said John. Occupationally acquired; Skin cancer in long-term sun-exposed external workers has already become the second most frequently recognized occupational disease in Germany (6,000 cases annually, about 800 of them with considerable pension entitlements). In Germany, the BG-Klinik Bad Reichenhall offers rehabilitation stays for recognized occupational skin cancer.
UV exposure in the normal population has doubled
Even those who are not exposed to increased UV radiation at work must expect significantly higher exposure. After an average of 130 SED per year in the past, one must now expect twice as much, according to John. Light skin cancer is already the most common cancer in men and women. «In the past, it was not so common for someone to come to us with a skin tumor acquired by UV radiation – especially non-melanoma skin cancer.Today, however, this happens several times a day, which is absolutely no longer a rarity and will increase. That worries me,» reported Dr. Max Tischler, dermatologist in Dortmund.
According to John, an annual increase in skin cancer cases of 10% can be expected – doubling the incidence in 9 years. This also takes into account the effects of climate change and demographic change (the risk of non-melanoma skin cancer increases with age).
It is still unclear how in a few years the medical care of the patients can be guaranteed in view of the sheer numbers: «We do not know how we should care for these patients in the future,» John clarified. He emphasized that tele-dermatology and artificial intelligence/health apps support for patient self-management must be used for care.
Healthy tan?They don’t exist
Sun protection is «absolutely essential,» emphasized Tischler. The example of Australia shows that continuity and consistency pay off in prevention. Australia is the only country with a light-skinned population with a declining incidence rate. In Germany, on the other hand, there is still a lot of catching up to do, especially when it comes to prevention: «Most people know that you have to apply cream, but many don’t,» reported Tischler. Many patients did not realize that one had to apply cream daily, especially in the summer months, when the UV radiation was high even when the sky was overcast.
It also depends on the right amount of sunscreen: Usually too little is applied. Apparently, the saying of the «healthy tan» still holds with many. «I know him from my grandmother. But there is no such thing as a healthy tan. Tanning is the body’s first defensive reaction against too much sun,» emphasized Tischler, who also organizes kindergarten and kindergarten training courses in which the very young, but also the educators and parents are trained on the subject of proper sun protection.
He repeatedly finds that too little sunscreen or too little sun protection factor is used.When he says that a family should plan for a summer holiday on the beach with half a liter of sunscreen, he often earns incredulous looks.
Treatment of actinic keratosis: The earlier, the more effective
Actinic keratosis is a light-induced skin change and an early form of squamous cell carcinoma. John campaigned for regular the «The earlier you start, the more effectively actinic keratoses can be treated,» John emphasized. Since 1 January 2015, actinic keratosis has also been classified as an occupational disease recognized. Die Prevalence of the disease was reported for 2008 in Germany with 11.5% among 60- to 70-year-olds.In 2011, they accounted for 8.3% of the 100 most common outpatient dermatological therapies in Germany.
The S3 Guidelines Actinic keratosis und Prevention of skin cancer devote a lot of space to occupational actinic skin damage. John explained that the recognition of occupational skin diseases can also provide therapeutic procedures together with guideline-compliant aftercare at the expense of the statutory accident insurance, which would not be possible in the area of care by the statutory health insurance funds.
How many people are affected by actinic keratosis can currently only be estimated: «certainly millions of people in Germany,» says John. Prof.Augustin (Hamburg) assumes up to 400,000 new cases per year, «but that’s speculation, we don’t know exactly, we just know that there are extremely many,» said John. The fact that the frequency of actinic keratoses has increased was also confirmed by Prof. Dr. Jens Malte Baron from the RTWH Aachen. «We see patients with actinic keratosis every day in our dermatological outpatient clinic, and there are more every year.»
Baron explained that a wide range of therapies is available for the treatment of actinic keratosis. From ointment therapy to laser treatment or the combination of laser and photodynamic therapy (PDT). With PDT, the diseased skin cells are specifically destroyed and at the same time the healthy surrounding tissue is spared.
PDT is suitable for those tumors that penetrate less than 3mm into the skin. » Which therapy is then suitable depends on whether the actinic keratosis manifests itself in one or more places, which sites and how many there are.Especially in difficult areas, e.g. on the eyelid area, the use of a laser brings advantages,» explained Baron.
The experts regretted that skin cancer screening in the context of the EU’s Beating Cancer Plan will probably not be established at European level. After all, however, high-risk groups such as external employees are now entitled to provision for supply. This occupational health precaution means that the employer must prepare a risk assessment and provide clothing, sunglasses and sunscreen. Occupational health advice is also planned for career entry with consultation intervals every 3 years. In Germany, 7 million people are entitled to this occupational health care.
This article was originally published on Medscape.de.
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