Unraveling the Connection between Occupation, Sun Exposure, and Basal Cell Carcinoma: A Cross-Sectional, Single Center Study
DOI:
https://doi.org/10.66344/jpad.35.4.2025.3158Keywords:
BCC, Risk factors, Sun exposure, Occupational riskAbstract
Background: Prolonged sun exposure is a major risk factor for basal cell carcinoma (BCC) due to cumulative UV-induced DNA damage. Studies have shown that outdoor workers face a significantly higher likelihood of developing BCC, with the risk further amplified by inadequate protective measures. Objectives: This study investigates the impact of sun exposure duration and occupational risk on BCC at Dr. Moewardi General Hospital. Methods: A cross-sectional study was conducted from September to December 2024 involving 78 subjects meeting the inclusion criteria. They were allocated study into two groups, BCC and non-BCC groups. Occupational risk was assessed by type of work, length of work, use of protective equipment, and duration of sun exposure. Sun exposure was expressed in hours/day, p value <0.05 was statistically significant. Results: There were 32 subjects with BCC and 46 subjects non-BCC. Our analysis obtained that occupational risk in the form of outdoor work type (p = 0.001; OR = 4.85), length of work > 20 years (p = 0.005; OR = 3.81), and use of protective equipment (p = 0.032; OR = 2.74) were associated with the incidence of BCC. The duration of sunlight exposure in the BCC group was found to be longer, at 5.31 hours/day than the non-BCC group, 2.78 hours/day (p <0.001). The ROC curve obtained the cutoff point of sun exposure duration of 3.5 hours / day (p <0.001; OR = 10.12). Conclusion: Daily sun exposure of 3.5 hours or more, outdoor work, and length of work >20 years, and not using protective equipment during work effect on the development of BCC.References
Basset-Seguin N, Herms F. Update in the Manage-ment of Basal Cell Carcinoma. Acta Derm Venereol. 2020;100(11):adv00140.Doi:10.2340/00015555-3495.
Peris K, Fargnoli MC, Garbe C, Kaufmann R, Bas-tholt L, Seguin NB, et al. Diagnosis and treatment of basal cell carcinoma: European consensus-based interdisciplinary guidelines. Eur J Cancer. 2019; 118:10–34.
Lang BM, Balermpas P, Bauer A, Blum A, Brölsch GF, Dirschka T, et al. S2k Guidelines for Cutaneous Basal Cell Carcinoma - Part 1: Epidemiology, Gene-tics and Diagnosis. J Dtsch Dermatol Ges. 2019;17(1):94–103. Doi: 10.1111/ddg.13733.
Kim DP, Kus KJB, Ruiz E. Basal Cell Carcinoma Review. Hematol Oncol Clin North Am. 2019; 33(1):13–24. Doi: 10.1016/j.hoc.2018.09.004
Octarica S, Dharmawan N. Profil pasien karsinoma sel basal pasien rawat jalan RSUD dr. moewardi surakarta periode januari 2016 – desember 2021. 2022;1–8.
Hasan A, Kandil AM, Al-Ghamdi HS, Alghamdi
MA, Nasr M, Naeem SA, et al. Sun-Exposed versus Sun-Protected Cutaneous Basal Cell Carcinoma: Clinico-Pathological Profile and p16 Immunostain-ing. Diagnostics (Basel). 2023;13(7).
Doi: 10.3390/diagnostics13071271
Schierbeck J, Vestergaard T, Bygum A. Skin Cancer Associated Genodermatoses: A Literature Review. Acta Derm Venereol. 2019;99(4):360–9.
Doi: 10.2340/00015555-3123
Indonesia National Report for the 12 WMO / UN-EP Ozone Research Managers Meeting. 2024.
Cameron MC, Lee E, Hibler BP, Barker CA, Mori S, Cordova M, et al. Basal cell carcinoma: Epidemio-logy; pathophysiology; clinical and histological subtypes; and disease associations. J Am Acad Der-matol. 2019;80(2):303–17.
Toha SS, Rahman A, Mochtar M, Julianto I, Dhar-mawan N, Mawardi P, et al. Kejadian Karsinoma Sel Basal di RSUD Dr. Moewardi Surakarta Berda-sarkan Subtipe Histopatologi menurut Jenis Kela-min, Usia, Lokasi Anatomi, dan Diameter Tumor. Cermin Dunia Kedokteran [Internet]. 2019 Apr 1;46(4 SE-Articles):256–60. Available from:
https://cdkjournal.com/index.php/cdk/article/view/478
Zhang W, Zeng W, Jiang A, He Z, Shen X, Dong X, et al. Global, regional and national incidence, mortality and disability-adjusted life-years of skin cancers and trend analysis from 1990 to 2019: An analysis of the Global Burden of Disease Study 2019. Cancer Med. 2021;10(14):4905-4922.
Doi: 10.1002/cam4.4046
Ibrahim N, Jovic M, Ali S, Williams N, Gibson JAG, Griffiths R, et al. The epidemiology, healthcare and societal burden of basal cell carcinoma in Wales 2000-2018: a retrospective nationwide analysis. Br J Dermatol. 2023 Feb;188(3):380–9.
Doi: 10.1093/bjd/ljac090.
Wibawa LP, Andardewi MF, Ade Krisanti I, Arisa-nty R. The epidemiology of skin cancer at Dr. Cipto Mangunkusumo National Central General Hospi-tal from 2014 to 2017. Journal of General-Procedu-ral Dermatology & Venereology Indonesia. 2019; 4(1):11–6.
Petr MA, Tulika T, Carmona-Marin LM, Scheibye-Knudsen M. Protecting the Aging Genome. Trends Cell Biol. 2020;30(2):117–32.
Goon P, Banfield C, Bello O, Levell NJ. Skin cancers in skin types IV-VI: Does the Fitzpatrick scale give a false sense of security? Skin health and disease. 2021;1(3):e40.
Fan W, Rokohl AC, Guo Y, Chen H, Gao T, Kakka-
ssery V, et al. Narrative review: mechanism of ultr-aviolet radiation-induced basal cell carcinoma. Frontiers of Oral and Maxillofacial Medicine; Vol 5 (March 10, 2023): Frontiers of Oral and Maxillo-facial Medicine [Internet]. 2021; Available from: https://fomm.amegroups.org/article/view/55995
Patel TN, Dhanyamraju PK. Role of aberrant Sonic hedgehog signaling pathway in cancers and deve-lopmental anomalies. J Biomed Res. 2021;36(1): 1–9. Doi: 10.7555/JBR.35.20210139
Oh ST, Stark A, Reichrath J. The p53 Signalling Pathway in Cutaneous Basal Cell Carcinoma: An Immunohistochemical Description. Acta Derm Venereol. 2020 Mar;100(6):adv00098.
Doi: 10.2340/00015555-3420
Kawasumi M, Nghiem P. Ultraviolet Radiation Carcinogenesis. In: Goldsmith LA, Katz SI, Gilch-rest BA, et al., eds. Fitzpatrick’s Dermatology in Gen-eral Medicine. 8th ed. New York, NY: McGraw-Hill; 2012:1251-1260.
Gilaberte Y, Trullàs C, Granger C, de Troya-Martín M. Photoprotection in Outdoor Sports: A Review of the Literature and Recommendations to Reduce Risk Among Athletes. Dermatol Ther (Heidelb). 2022;12(2):329–43.
Komala, Ninong. Analysis of Java Island’s ozone layer and ultra violet index variability based on satellite data. E3S Web Conf [Internet]. 2019;76: 4001. Available from: https://doi.org/10.1051/e3sconf/20197604001
U.S. Environmental Protection Agency. UV Index Scale [Internet]. 2025 [cited 2025 Feb 7]. Available from: https://www.epa.gov/sunsafety/uv-index-scale-0
Sander M, Sander M, Burbidge T, Beecker J. The efficacy and safety of sunscreen use for the preven-tion of skin cancer. CMAJ. 2020 ;192(50):E1802–8.
Cai H, Sobue T, Kitamura T, Sawada N, Iwasaki M, Shimazu T, et al. Epidemiology of nonmelanoma skin cancer in Japan: Occupational type, lifestyle, and family history of cancer. Cancer Sci. 2020; 111(11):4257–65. Doi: 10.1111/cas.14619
Kasumagic-Halilovic E, Hasic M, Ovcina-Kurtovic N. A Clinical Study of Basal Cell Carcinoma. Med Arch. 2019;73(6):394–8.
Doi: 10.5455/medarh.2019.73.394-398
Lashway SG, Worthen ADM, Abuasbeh JN, Harris RB, Farland LV, O’Rourke MK, et al. A meta-ana-lysis of sunburn and basal cell carcinoma risk. Cancer Epidemiol. 2023;85:102379.
Doi: 10.1016/j.canep.2023.102379
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Journal of Pakistan Association of Dermatologists
This work is licensed under a Creative Commons Attribution 4.0 International License.
Submission declaration
Authors retain the copyright to their work and grant the 'Journal of Pakistan Association of Dermatologists (JPAD)' the right of first publication under a Creative Commons Attribution 4.0 International (CC BY 4.0) license. This license allows others to share, adapt, and reuse the work for any purpose, including commercial use, as long as appropriate credit is given to the original authors and the journal.
By submitting a manuscript, authors confirm that the work has not been published previously (except as an abstract, lecture, or academic thesis), is not under review elsewhere, and has been approved by all authors and relevant authorities. Once accepted, the article will be openly accessible under the CC BY 4.0 license, ensuring wide dissemination and reuse with proper attribution.
