Outdoor Professions Carry Different Risks For Nonmelanoma Skin Cancer

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Farmers, gardeners, and mountain guides—all at a greater risk for nonmelanoma skin cancer (NMSC) due to increased solar ultraviolet radiation exposure—participate in varying risk and protective behaviors, and have different risks for NMSC.

One of the main risks factors for nonmelanoma skin cancer (NMSC)—the most common cancer globally—is solar ultraviolet radiation (UVR), putting those with outdoor professions at a greater risk. According to new study results, different outdoor professions carry significant, but different, risks for NMSC.

Researchers conducted a cross-sectional study of 563 participants, 348 of whom were outdoor workers, between March and September 2017. Outdoor workers were farmers, gardeners, and mountain guides. All participants filled out a 10-question survey on socio-demographic and work characteristics, UVR exposure, and protective behavior. Participants also underwent a skin examination.

On average, gardeners spent more time outside per day compared to farmers and mountain guides, with 78.4% of all gardeners, 48% of all farmers, and 70.6% of all mountain guides working an average of more than 4 hours per day outside. The majority of indoor workers (82%) spent an average of fewer than 2 hours outside per day.


Of the participants, 53.1% had never been to a skin cancer screening before. The highest skin cancer attendance rates were reported by indoor workers (61.4%) and mountain guides (57.8%). At nearly half the rate, farmers and gardeners had attendance rates of 31.9% and 27.6%, respectively.

When asked if they had ever consulted a dermatologist, 62.8% of indoor workers and 70% of mountain guides answered yes, compared to 50.4% of farmers and 43.9% of gardeners. The majority of all outside workers indicated that they use sunscreen with sun protection factor (SPF), with 98.9% of mountain guides indicating that they use it, 73.2% of gardeners, and 55.6% of farmers. Mountain guides typically used a higher SPF than the other outdoor workers.

At least 1 abnormal skin condition was found on 310 (55.1%) participants. Those with an abnormal skin condition were older and more likely to be male. NMSC was detected in 103 (18.3%) participants. The majority (83.4%) of NMSC was found on the face (44.4%) and the forehead (39%). There were no cases detected on the back of the neck.

While just 5.6% of indoor workers were affected, mountain guides had NMSC a rate of 33.3%, farmers had a rate of 27.4%, and gardeners had a rate of 19.5%.

“NMSC risk and protective behavior of farmers, gardeners, and mountain guides with its striking differences are remarkable,” wrote the authors of the study. “All 3 groups are counted among the prototype outdoor professions. But, not only do they substantially diverge in sunscreen use and skin cancer screening attendance. They even have distinctive UVR exposures during daily work.”

The authors concluded that the study findings highlight the need for evidence-based prevention campaigns adjusted to individual needs and specifications of different outdoor working professions, as different professions carry different risks.


Zink A, Tizek L, Bohner A, et al. Different outdoor professions have different risks—a cross-sectional study comparing non-melanoma skin cancer risk among farmers, gardeners, and mountain guides [published online May 27, 2018]. J Eur Acad Dermatol Venereol. doi: