Solar UV radiation-induced non-melanoma skin cancer as an occupational reportable disease: international experience to inform South Africa

Background: Occupational solar ultraviolet radiation (UVR) exposure is a skin cancer risk factor. Outdoor workers have long exposure hours and are in need of photoprotection against solar UVR, a Group 1-defined carcinogen. In South Africa, skin cancers account for one third of all histologically-diagnosed cancers. Physiological presentation of non-melanoma skin cancers (NMSC) is most common on the head in all population groups. It is expected that occupational exposure plays a role in NMSC aetiology in South Africa, although such data are presently lacking. Recognising solar UVR-inflicted skin cancer as an occupational disease occurs in some countries. We consider the experience of other countries in including NMSC as an occupational disease to draw on lessons learnt, and consider a similar approach for South Africa. Methods: We sourced articles in English on NMSC as an occupational disease. We also sent an open-ended e-mail information request to nine international academic experts from different developed countries. Data on background, legislation, reporting, notification and occupational sectors of concern were analysed. Results: Several countries, e.g. Denmark, include NMSC as an occupational disease. Despite this, under-reporting is still significant. Agriculture, construction and public service sectors report most commonly, compared to other sectors. National awareness campaigns, careful legal management and improved health care services for patients are key. Conclusions: Outdoor workers run an increased risk of developing NMSC. For South Africa to register NMSC as a reportable occupational disease, significant efforts relating to local epidemiology, exposure assessment, legal and insurance management, and policy-making, need to be considere