Melanoma of the skin and exposure to solar ultraviolet radiation at work in Modena territory: a casecontrol study to promote an active search and prevention of occupational diseases based on recent INAIL criteria

Our aim is to evaluate the presence of specific occupation-related risk factors, with particular regard to outdoor jobs with cumulative exposure to solar ultraviolet radiations (UVR), in a cohort of patients of the Dermatology Clinic of the Modena University hospital. After the approval of the Ethical Committee, we will propose the recruitment to all the patients with a new melanoma diagnosis in a sixteen months period, aimed at recruiting ~120 patients, and a number of controls (with similar socio-demographic characteristics compared to the cases) with a negative result at the histopathologic exams, with a ratio of 1.5 controls per case, and a total study population of ~300 subjects. Patients <18 years of age, patients with a diagnosis of non-melanoma skin cancers and/or actinic keratosis and patients with cognitive impairment will be excluded. Subjects who will accept to participate will be interviewed with a standard questionnaire from a trained healthcare operator: the questionnaire will include information on the main socio-demographic characteristics of the subjects and on non-occupational risk factors for melanoma (family history of melanoma and genetic alterations, ethnic group, skin phototype, history of sunburns, leisure time intense UV light exposures from artificial and/or natural sources, history of atypical moles, >50 moles on the body, having lived in a tropical or sub-tropical region, history of immunodepression), as well as a detailed occupational anamnesis to evaluate job history. In case of any outdoor job, there will be additional questions on the specific time and location of the activities, on the use of protections at work and on the characteristics of the work environment. The clinical information to be collected will be the specific histopathologic diagnosis of melanoma and the localization of the tumors. Cases and controls will be compared based on the socio-demographic and on occupational and non-occupational risk factors with adequate statistical methods. Specific sub-analysis will be performed based on the different melanoma subtypes, with particular regard to those types which are more related to cumulative sun damage, and based on the tumours’ localization, in order to possibly confirm positive associations with a history of outdoor jobs. The sub-analysis will involve also different exposure levels: based on the interview results, subjects will be divided in non-occupationally exposed to solar UVR vs. low, medium and high levels of occupational UVR exposure. For all the cases of melanoma with histotypes related to cumulative sun damage occurred in photo-exposed body regions in outdoor workers the disease will be reported as “occupational” to INAIL, following its recent criteria. In addition, in the sub-analysis will be included the presentation of melanoma at dermoscopy and confocal laser microscopy to analyzed the presence of particular pattern of presentation of the melanoma.