{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T08:12:50Z","timestamp":1781511170446,"version":"3.54.1"},"reference-count":32,"publisher":"Wiley","issue":"S3","license":[{"start":{"date-parts":[[2016,3,17]],"date-time":"2016-03-17T00:00:00Z","timestamp":1458172800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100000780","name":"European Commission","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Acad Dermatol Venereol"],"published-print":{"date-parts":[[2016,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Exposure to ultraviolet radiation (<jats:styled-content style=\"fixed-case\">UVR<\/jats:styled-content>) is the most important external risk factor for skin cancer. Outdoor workers, who are exposed to high ambient <jats:styled-content style=\"fixed-case\">UVR<\/jats:styled-content> levels are at increased risk.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To compare outdoor with indoor workers in terms of: (i) skin cancer risk factors, and (ii) risk of developing skin cancer.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Using descriptive methods and a large multicenter European case\u2013control study, we compared risk factor patterns between outdoor (<jats:italic>N<\/jats:italic>\u00a0=\u00a01416) and indoor workers (<jats:italic>N<\/jats:italic>\u00a0=\u00a01863). Risk of developing basal cell carcinoma (<jats:styled-content style=\"fixed-case\">BCC<\/jats:styled-content>), squamous cell carcinoma (<jats:styled-content style=\"fixed-case\">SCC<\/jats:styled-content>), melanoma and actinic keratosis (<jats:styled-content style=\"fixed-case\">AK<\/jats:styled-content>) were analysed by type of work using multivariate logistic regression models, for three categories of work: indoor; farming\/construction; other outdoor work.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Although skin phototype was equally distributed by type of work, significantly less outdoor than indoor workers used sunscreen in their own country (44.3% vs. 60.2%), but had more outdoor hobbies (66.2% vs. 58.2%). Outdoor workers had lower educational levels, and felt less confident in understanding medical information and filling medical forms (all <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001). Outdoor workers had more signs of photodamage (78.1% vs. 65.5%) and among the skin cancer patients, 37.7% of outdoor workers vs. 28.6% of indoor workers had \u22652 skin cancers diagnosed during their lifetime.\u00a0Multivariate logistic regression models showed significantly increased risk of outdoor vs. indoor work for <jats:styled-content style=\"fixed-case\">AK<\/jats:styled-content> (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content><jats:sub>other outdoor<\/jats:sub>\u00a0=\u00a01.55, <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content><jats:sub>farming\/construction<\/jats:sub>\u00a0=\u00a02.58), <jats:styled-content style=\"fixed-case\">SCC<\/jats:styled-content> (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content><jats:sub>other outdoor<\/jats:sub>\u00a0=\u00a01.32, <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content><jats:sub>farming\/construction<\/jats:sub>\u00a0=\u00a02.77) and <jats:styled-content style=\"fixed-case\">BCC<\/jats:styled-content> (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content><jats:sub>other outdoor<\/jats:sub>\u00a0=\u00a01.53, <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content><jats:sub>farming\/construction<\/jats:sub>\u00a0=\u00a01.83). No significant associations were found for melanoma. The risk of all types of skin cancer and <jats:styled-content style=\"fixed-case\">AK<\/jats:styled-content> was significantly increased for workers with \u22655\u00a0years of outdoor work.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Outdoor workers had more risk behaviour with similar constitutional skin cancer risk factors: more <jats:styled-content style=\"fixed-case\">UV<\/jats:styled-content> exposure (both occupational and leisure) and less sunscreen use and lower health literacy. This results in higher exposure, more photodamage and an increased risk of developing <jats:styled-content style=\"fixed-case\">AK<\/jats:styled-content>,<jats:styled-content style=\"fixed-case\"> BCC<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">SCC<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jdv.13603","type":"journal-article","created":{"date-parts":[[2016,3,20]],"date-time":"2016-03-20T11:56:44Z","timestamp":1458475004000},"page":"5-11","source":"Crossref","is-referenced-by-count":98,"title":["Skin cancer risk in outdoor workers: a European multicenter case\u2013control study"],"prefix":"10.1111","volume":"30","author":[{"given":"M.","family":"Trakatelli","sequence":"first","affiliation":[{"name":"Department of Dermatology Papageorgiou Hospital Aristotle University of Thessaloniki Thessaloniki Greece"},{"name":"Department of Dermatology St. Pierre Hospital Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Barkitzi","sequence":"additional","affiliation":[{"name":"Artistotle University of Thessaloniki Thessaloniki Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Apap","sequence":"additional","affiliation":[{"name":"Department of Dermatology Sir Paul Boffa Hospital Floriana Malta"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Majewski","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Venereology Medical University of Warsaw, Warsaw Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"De Vries","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology and Biostatistics Faculty of Medicine, Pontificia Universidad Javeriana Bogot\u00e1 Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the EPIDERM group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,3,17]]},"reference":[{"key":"e_1_2_6_2_1","unstructured":"World Health Organization.Skin cancers.http:\/\/www.who.int\/uv\/faq\/skincancer\/en\/index1.html(last accessed: February 2016)."},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2133.2007.07861.x"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.5694\/mja12.10654"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2010.0066"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1011-1344(01)00198-1"},{"key":"e_1_2_6_7_1","first-page":"316","volume-title":"Solar and ultraviolet radiation","author":"IARC","year":"1992"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/oem.57.1.10"},{"key":"e_1_2_6_9_1","first-page":"12","volume-title":"Outlook 1. 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