TYPE O iginal Resea ch
PUBLISHED 16 Sep embe 2025
DOI 10.3389/ pubh.2025.1597621
OPEN ACCESS
EDITED BY
Claudina M. C. A. Noguei a,
Uni e si y o P e o ia, Sou h A ica
REVIEWED BY
Claudine S ehl,
Ins i u ü A bei sschu z de Deu schen
Gese zlichen Un all e siche ung
(IFA), Ge many
S ua Hende son,
Aus alian Radia ion P o ec ion and Nuclea
Sa e y Agency, Aus alia
*CORRESPONDENCE
Swen Mal e John
[email p o ec ed]
RECEIVED 21 Ma ch 2025
ACCEPTED 25 July 2025
PUBLISHED 16 Sep embe 2025
CITATION
Bieck C, Albe s A and John SM (2025) Cu en
s a us o na ional egula ions on anning bed
use and wo ke s’ p o ec ion om sola
ul a iole adia ion: esul s om a global
In e na ional League o De ma ological
Socie ies (ILDS) ques ionnai e s udy.
F on . Public Heal h 13:1597621.
doi: 10.3389/ pubh.2025.1597621
COPYRIGHT
©2025 Bieck, Albe s and John. This is an
open-access a icle dis ibu ed unde he
e ms o he C ea i e Commons A ibu ion
License (CC BY). The use, dis ibu ion o
ep oduc ion in o he o ums is pe mi ed,
p o ided he o iginal au ho (s) and he
copy igh owne (s) a e c edi ed and ha he
o iginal publica ion in his jou nal is ci ed, in
acco dance wi h accep ed academic p ac ice.
No use, dis ibu ion o ep oduc ion is
pe mi ed which does no comply wi h hese
e ms.
Cu en s a us o na ional
egula ions on anning bed use
and wo ke s’ p o ec ion om
sola ul a iole adia ion: esul s
om a global In e na ional
League o De ma ological
Socie ies (ILDS) ques ionnai e
s udy
Ca a Bieck 1,2, An je Albe s 1,3 and Swen Mal e John 1,3,4*
1Depa men o De ma ology, En i onmen al Medicine and Heal h Theo y, Ins i u e o Heal h
Resea ch and Educa ion, Osnab ück Uni e si y, Osnab ück, Ge many, 2Di ision o Occupa ional
Medicine, Depa men o Occupa ional Medicine, Haza dous Subs ances and Heal h Sciences,
S a u o y Acciden Insu ance o he Heal h and Wel a e Se ices, Hambu g, Ge many, 3Ins i u e o
In e disciplina y De ma ological P e en ion and Rehabili a ion (iDe m) a Osnab ück Uni e si y,
Osnab ück, Ge many, 4Lowe Saxony Ins i u e o Occupa ional De ma ology (NIB), Osnab ück,
Ge many
In oduc ion: Exposu e o ul a iole adia ion (UVR) is he mos impo an isk
ac o o he de elopmen o skin cance . Ou doo wo ke s and people who use
anning beds belong o he high- isk g oups o de eloping his disease. The aim
o he p esen s udy was o ga he da a abou na ional egula ions on he use o
anning beds and wo ke ’s p o ec ion om sola UVR.
Me hods: Membe socie ies o he In e na ional League o De ma ological
Socie ies (ILDS) we e asked o pa icipa e in a su ey by using s anda dized online
ques ionnai es om Janua y 2023 o Janua y 2024.
Resul s: A o al o 100 de ma ologis s om 66 di e en coun ies answe ed.
Responses we e pooled i mo e han one pe son esponded o one coun y.
Occupa ionally acqui ed skin cance by sola UVR can be ecognized as an
occupa ional disease in 29 (43.9%) o 66 esponding coun ies. In 29 (43.9%) o 66
esponding coun ies he e a e legal ins umen s a ailable aimed a con olling
he cosme ic use o anning beds. In 48 (72.7%) o 66 coun ies, he esponding
membe socie y cu en ly pa icipa es in any ac i i ies on UVR p o ec ion and/o
use o anning beds.
Discussion: The esul s o he p esen ed s udy indica e a s ong need o u he
ac ion in e ms o skin cance p e en ion on di e en le els. This is o high
impo ance due o he ac ha skin cance is a apidly inc easing global public
heal h conce n. This issue is pa icula ly applicable o high- isk g oups ega ding
he de elopmen o occupa ional skin cance , as (a) ou doo wo ke s as well
as (b) people om he gene al popula ion who may ha e limi ed awa eness o
unde s anding o UVR exposu e isks (e.g., h ough anning bed use).
KEYWORDS
cance , occupa ion, p e en ion, egula ion, skin, anning, ul a iole adia ion
F on ie s in Public Heal h 01 on ie sin.o g
Bieck e al. 10.3389/ pubh.2025.1597621
In oduc ion
Exposu e o ul a iole adia ion (UVR) is he main isk ac o
o he de elopmen o skin cance . UVR is in isible o he human
eye and can be di ided in o h ee main ypes, which diffe in
hei wa eleng h and biological effec : UVA, UVB and UVC. These
ypes o adia ion each ha e diffe en oxic effec s on he skin
due o hei diffe en pene a ion a es in o he epide mis (1).
UVA comp ises he longes wa eleng hs o UVR (315–400 nm)
and pene a es deeply in o he skin, eaching he de mis and can
indi ec ly cause deoxy ibonucleic acid (DNA) damage by igge ing
he gene a ion o eac i e oxygen species (1). UVB adia ion (280–
315 nm) has a sho e wa eleng h and he e o e is mo e ene ge ic
(2). UVB adia ion is p ima ily esponsible o sunbu n and di ec
DNA damage, which can lead o skin cance (1,3,4). UVC (100–
280 nm) is he mos ene ge ic and po en ially mos dange ous o m
o UVR. The UVC and po ions o he UVB componen o sola
UVR a e abso bed by he ea h’s a mosphe e—especially molecula
oxygen and he ozone laye —and do no each he ea h’s su ace
(2). The s eng h o sola UVR a ies depending on geog aphical
loca ion, season and ime o day. The highes in ensi y is eached in
he summe mon hs and nea he equa o (2).
UVA and UVB adia ion a e o pa icula impo ance o he
p esen ed s udy. While UVA adia ion is mainly esponsible o
skin aging and long- e m skin damage, UVB adia ion is he main
cause o sunbu ns and acu e DNA damage leading o skin cance
(4). In he case o na u al UVR om he sun, bo h UVA and
UVB ays a e ele an , as bo h ypes each he ea h’s su ace and
he e o e he human skin. Due o he deep pene a ion o UVA
adia ion in o he skin i can ein o ce he ca cinogenic effec s o
UVB, he eby con ibu ing o he de elopmen o skin cance (5).
Ou doo wo ke s a e a pa icula ly high isk as hey a e equen ly
exposed o sunligh in hei wo king en i onmen (6). In 2019, 1.8
billion wo ke s we e exposed o UVR a wo k which co esponds
o abou 28.4% o he wo king age popula ion (7).
Ano he g oup a ele a ed isk o skin cance a e people who
use anning beds. UVR, whe he om he sun o a ificial sou ces,
inc eases he p obabili y o he de elopmen o skin cance (8).
The social and cul u ally condi ioned ideal o anned skin—which
is p esen in some socie ies—encou ages he use o inadequa e o
inapp op ia e p o ec i e measu es, he eby inc easing he isk o
sunbu n and g ow h o he skin cance epidemic (9). Younge
people in pa icula a e a ge ed by ad e isemen s o anning bed
use (8). A ificial UVR in anning beds is mainly gene a ed by UVA
adia ion in o de o achie e a mo e apid and in ensi e an as he
mechanism o immedia e pigmen da kening is igge ed. The UVB
con en in sunbeds is gene ally lowe han in na u al sunligh (10)
e en hough biological efficacy is conside ably highe han ha o
UVA. The mo e in ense UVR exposu e in anning beds, coupled
wi h epea ed use, can lead o an inc eased isk o skin cance .
Applied doses may be 10 imes highe compa ed o sola UVA.
Skin cance caused by UVR includes wo main ca ego ies:
ke a inocy e ca cinoma a, mo e o en e e ed o as non-melanoma
skin cance (NMSC), and malignan melanoma (MM). NMSC
spans basal cell ca cinoma (BCC) and squamous cell ca cinoma
(SCC). In he de elopmen o skin cance , ea ly o ms o SCC (“in
si u”) in he o m o ac inic ke a osis (AK) and Bowen’s disease
mus also be aken in o accoun . These a e also caused by UVR
and ha e he po en ial o de elop in o SCC, which can he e o e be
associa ed wi h conside able mo bidi y (11). The incidence o BCC
and SCC has inc eased wo ldwide in ecen yea s, especially among
ou doo wo ke s a e yea s o cumula i e sunligh exposu e (12).
The isk especially o he de elopmen o BCC is inc eased by he
join influence o sunligh exposu e and he use o anning beds. I
was ound ha a 60% isk o de eloping BCC is associa ed wi h a
his o y o se e e sunbu n when combined wi h he use o anning
beds (13). Sola UVR is mainly associa ed wi h he de elopmen
o NMSC. These skin cance s o en a ise in subjec s wi h la ge
cumula i e UV doses such as hose due o epea ed UV exposu e in
ou doo occupa ional se ings. I NMSC is no de ec ed and ea ed
a an ea ly s age, i can lead o se e e issue damage and me as ases.
MM, a a e bu mo e se ious and agg essi e o m o skin
cance , is p ima ily caused by in ense, in e mi en UV exposu e,
which is also ele an in he de elopmen o sunbu ns. The
incidence o MM has inc eased annually, which can be a ibu ed
o inc eased UV exposu e h ough sunba hing and he use o
sunbeds (8). In pa icula , sho e , in e mi en bu in ense UV
exposu e, as can occu in anning bed use, has been iden ified
as a significan con ibu ing ac o (4). While sola UVR leads o
NMSC p ima ily h ough p olonged, daily sun exposu e, a ificial
UVR is pa icula ly associa ed wi h he de elopmen o MM
as i gene ally p o ides a highe in ensi y in a sho e ime. A
causal ela ionship be ween MM and in e mi en exposu e du ing
leisu e ime, especially du ing childhood and adolescence, can be
assumed (6).
I is he e o e impo an ha na ional egula ions a e in place
o p o ec people om isk ac o s and he eby educe he numbe
o illnesses. Rega ding skin cance as an occupa ional disease,
cu en es ima es by he Wo ld Heal h O ganiza ion (WHO) and
he In e na ional Labo O ganiza ion (ILO) assume ha almos
one in h ee dea hs om NMSC can be a ibu ed o sun exposu e
in an occupa ional con ex . A e iew o he da a on dea hs
a ibu able o occupa ional skin cance e ealed an 88% inc ease
be ween 2000 and 2019 (7,14). These es ima es emphasize he
significance o ongoing esea ch and effo s o p e en occupa ional
exposu e o UVR and he bu den o NMSC in his con ex (7).
The In e na ional League o De ma ological Socie ies (ILDS) is
commi ed o de ma ology and imp o ing skin heal h a a global
le el, and is wo king closely wi h he WHO on his ini ia i e (15).
Agains his backg ound, he aim o he p esen ed s udy was o
de e mine he cu en s a us o he ecogni ion o a ious ypes o
skin cance caused by occupa ional UVR as an occupa ional disease
and he p e- equisi es o his in diffe en coun ies. Fu he mo e,
legal ins umen s o con ol he use o anning beds and he
pa icipa ion in ac i i ies on p e en ion and educa ion abou
anning beds we e o be iden ified. The findings shall suppo
u he imp o emen o he acknowledgmen and p e en ion o
skin cance . Also, he esul s o his s udy can help o fill gaps
in he legal egula ion o anning beds o s op he global skin
cance epidemic.
Ma e ials and me hods
On he 23 d o Janua y 2023, he ILDS dissemina ed
s anda dized online ques ionnai es o i s membe academic
F on ie s in Public Heal h 02 on ie sin.o g
Bieck e al. 10.3389/ pubh.2025.1597621
socie ies. The su ey was hen un un il he 29 h o Janua y 2024.
In case o mo e han one pe son esponding o one coun y,
he answe s we e pooled. I mul iple answe s om one coun y
we e con adic o y, a plausibili y check was conduc ed by manually
c oss-checking a sample o esponses agains he officially epo ed
legal egula ion.
Resul s
Cha ac e is ics o he pa icipan s
A o al o 100 de ma ologis s esponded o he online
ques ionnai es ep esen ing a wide ange o 66 coun ies.
The highes numbe o de ma ologis s esponded om I aly
(n=10), ollowed by Japan (n=4), and Aus alia, F ance,
and Spain (n=3, each). Responses we e ecei ed om wo
de ma ologis s in each o he ollowing coun ies: Aus ia, Cos a
Rica, Denma k, Ecuado , Egyp , Kuwai , Mau i ius, Ne he lands,
Nige ia, Pales ine, Philippines, S i Lanka, Taiwan, Uni ed Kingdom
(UK), Uni ed S a es o Ame ica (USA), and Venezuela. Fo
mos o he coun ies, only one de ma ologis esponded,
iz. Bela us, Boli ia, B azil, Canada, Chile, Colombia, Congo
(Democ a ic Rep), C oa ia, Czech Republic, Dominican Republic,
El Sal ado , Finland, Geo gia, Ge many, G eece, Gua emala,
Hondu as, Iceland, India, Indonesia, Kazakhs an, Malaysia, Mali,
Mal a, Mau i ania, Mexico, Mo occo, New Zealand, No way,
Pakis an, Poland, Po ugal, Romania, Se bia, Singapo e, Slo akia,
Sweden, Swi ze land, Sy ia, Tanzania, Thailand, Tu key, Uni ed
A ab Emi a es (UAE), U uguay, and Vie nam.
Recogni ion o skin cance by ul a iole
adia ion as occupa ional disease
Occupa ionally acqui ed skin cance by UVR can be ecognized
as an occupa ional disease in 29 (43.9%) o 66 answe ing coun ies
(Figu e 1). The p e- equisi es o ecogni ion in hose 29 coun ies
a e he ype o job in 24 coun ies (82.8%), he ype o cance
FIGURE 1
Key findings o he p esen ed su ey wi h 66 indi idual coun ies
esponding; UV, ul a iole ; WHO, Wo ld Heal h O ganiza ion.
in 23 coun ies (79.3%), he numbe o yea s exposed o UVR in
20 coun ies (69.0%), he numbe o yea s in ou doo wo k in 19
coun ies (65.5%), and o he p e- equisi es in wo coun ies (6.9%)
o which ‘wa e e an om Vie nam and o he wa s in sun’ and
‘no oo much leisu e ime exposu e; p i a e exposu e e sus wo k
exposu e, con inuous exposu e e sus in e mi en exposu e’ we e
men ioned (mul iple answe s we e possible) (Figu e 2). Wi hin
he 29 answe ing coun ies in which occupa ionally acqui ed skin
cance by UVR could be ecognized as an occupa ional disease,
25 (86.2%) acknowledge SCC, 23 (79.3%) acknowledge BCC, 23
(79.3%) acknowledge AK, 23 (79.3%) acknowledge Bowen’s disease,
21 (72.4%) acknowledge MM, and 21 (72.4%) acknowledge any
o m o skin cance as occupa ional skin cance by UVR (Figu e 3).
Two (3.0%) ou o 66 answe ing coun ies men ioned ha al hough
none o he abo e-men ioned skin cance s a e ye ecognized as
occupa ional skin cance , official ini ia i es a e unde way o launch
an occupa ional skin cance na ional p e en ion p og am.
FIGURE 2
P e- equisi es o ecogni ion o occupa ionally acqui ed skin
cance by UVR in 29 (43.9%) o 66 esponding coun ies in which
occupa ionally acqui ed skin cance by UVR can be ecognized as
an occupa ional disease (mul iple answe s possible); UVR, ul a iole
adia ions.
FIGURE 3
Types o skin cance acknowledged as occupa ional skin cance s by
UVR in 29 (43.9%) o 66 esponding coun ies in which
occupa ionally acqui ed skin cance by UVR can be ecognized as
an occupa ional disease (mul iple answe s possible); AK, ac inic
ke a osis; BCC, basal cell ca cinoma; MM, malignan melanoma;
SCC, squamous cell ca cinoma.
F on ie s in Public Heal h 03 on ie sin.o g
Bieck e al. 10.3389/ pubh.2025.1597621
Legal egula ions o he use o anning
beds
O 66 esponding coun ies, in 29 (43.9%) he e a e legal
ins umen s a ailable aimed a con olling he cosme ic use o
anning beds (Figu e 1). Fou een (21.2%) o he 66 answe ing
coun ies ha e ecei ed in o ma ion om he WHO conce ning
hei wo k on he isk o using anning beds (Figu e 1).
Ac i i ies on ul a iole adia ion p o ec ion
and/o use o anning beds
In 48 (72.7%) o 66 answe ing coun ies, he esponding
membe o ganiza ion cu en ly pa icipa es in any ac i i ies on
UVR p o ec ion and/o use o anning beds (Figu e 1). Fo y nine
(74.2%) o 66 esponding coun ies cu en ly conduc ing ac i i ies
on UVR p o ec ion and/o use o anning beds desc ibed hei
ac i i ies (Table 1), o which mul iple esponses we e possible.
Discussion
The p esen s udy shows ha in 29 ou o he 66 coun ies,
occupa ional skin cance caused by UVR is ecognized as an
occupa ional disease. The ecogni ion o his disease a ies
depending on ac o s such as he ype o occupa ion, he ype
o cance , and he du a ion o UV exposu e. Fu he mo e, a
conside able numbe o hese coun ies engage in ini ia i es aimed
a sa egua ding agains UVR and egula ing he use o anning beds.
Specifically, 43.9% o coun ies ha e implemen ed legal measu es o
egula e he cosme ic use o anning beds.
One hund ed de ma ologis s om 66 se en diffe en coun ies
answe ed. I is no able ha Eu opean coun ies a e pa icula ly
p e alen in he da a se (26 coun ies). Wi h 10 pa icipan s, I aly
was he coun y wi h he highes numbe o esponses. As he
ILDS has 217 membe socie ies om 104 diffe en coun ies, bu
esponses we e ecei ed om only 66 coun ies, i can be sugges ed
ha he e is p obably a s onge commi men o UV p o ec ion in
he esponding coun ies (16).
The esul s demons a e ha less han hal o he esponding
coun ies (43.9%) ecognize occupa ionally acqui ed skin cance
caused by UVR as an occupa ional disease. This is a p oblema ic
si ua ion in e ms o global public heal h, pa icula ly gi en he
ele a ed isk ac o o de eloping skin cance , which is especially
pe inen in he con ex o ou doo wo ke s. Fu he mo e,
he e is a no able dea h o acknowledgmen o NMSC as an
occupa ional disease in he coun ies whe e such acknowledgmen
is heo e ically possible. One po en ial explana ion o he absence
o NMSC epo ing as an occupa ional disease is he lack o ou ine
documen a ion o he co ela ion be ween he disease and he
occupa ion in ques ion (17). In coun ies whe e ecogni ion is
a possibili y, he p ima y p e- equisi es o acknowledgmen a e
p edominan ly he ype o job (82.8%) and he ype o cance
(79.3%). T aka elli e al. (18) demons a ed a s ongly inc eased
isk o AK, BCC and SCC among a me s, cons uc ion wo ke s
and o he ou doo wo ke s compa ed o indoo wo ke s, especially
i hey spend many hou s ou doo s daily and o many yea s (18).
Men and olde age g oups a e pa icula ly affec ed (7). Howe e , he
ac i e applica ion o sun p o ec ion measu es is equen ly impeded
by a ious ba ie s. These o en ela e o indi idual p e e ences
such as com o and he pe cei ed imp ac icali y o sun p o ec ion
measu es. In addi ion, sun p o ec i e clo hing and sun p o ec ion
p oduc s should also be adap ed o he specific wo king condi ions
(19). As i may be challenging o ou doo wo ke s o a oid
he sun a peak imes, sun p o ec ion measu es such as he use
o sunsc een should be u ilized and encou aged. The e o e, i is
necessa y o b eak down he ba ie s (20). Educa ional measu es
ha can posi i ely influence he sun p o ec ion beha io o ou doo
wo ke s can include he p o ision o in o ma ion ma e ial (e.g.,
b ochu es), eminde s abou sun p o ec ion h ough, o ins ance,
he use o signs o cell phone messages, and specific aining on
he subjec o skin cance p e en ion and sun p o ec ion (12).
An inc ease in knowledge and an app op ia e pe cep ion o isk
can posi i ely influence sun p o ec ion beha io in he wo kplace
(12). In he con ex o p ima y p e en ion, he use o pe sonal
p o ec i e equipmen is o pa icula ele ance. In his, he so-called
TABLE 1 Examples o ac i i ies on UVR p o ec ion and/o use o anning beds p o ided by he pa icipan s o he su ey.
Ac i i y ca ego y Examples o he answe s p o ided by he pa icipan s
Skin cance
campaigns/public
ela ions wo k
Public lec u es by expe s, epo s in newspape s, annual na ional skin cance campaigns, sun awa eness weeks, sun awa eness mon hs, adio
and ele ision campaigns, melanoma day, awa eness weeks, ou inely p o ide educa ion abou he dange o UVR and encou age people o
u ilize UV p o ec ion h ough di ec campaign and social media pla o m, sun exposu e awa eness campaigns in schools and in he gene al
public, na ional skin-check days
Medical/de ma ological
ac ions including pa ien
educa ion
Ad ancing he diagnosis and medical, su gical and cosme ic ea men o he skin, hai and nails, ad oca ing high s anda ds in clinical p ac ice,
educa ion and esea ch in de ma ology, suppo ing and enhancing pa ien ca e o a li e ime o heal hie skin, hai and nails, equi able
sunsc een access, pa ien educa ion (e.g., on sunsc een use), public educa ion, and educa ion o s uden s and heal hca e wo ke s on he ha m ul
effec s o UVR, skin checks by de ma ologis s all o e he coun y ee o cha ge and ad ice abou he dange o UV exposu e, pa ien
in o ma ion and oppo unis ic aining o au ho i ies in municipali ies and coun ies, pa ien educa ion abou sunsc eens and sun p o ec ion in
gene al, online pa ien educa ion
Skin cance esea ch Resea ch in skin cance and sys emic pho op o ec ion o o gan ansplan ecipien s, esea ch in skin cance /ac inic ke a osis ea men , skin
cance esea ch, con e ences ha include epo s on de ma o-oncology, including issues o p e en ion and p o ec ion om UVR, public
lec u es by expe s and epo s in newspape s
Use o anning beds Res ic ing he use o indoo anning beds, con ac ing spo schools o ban anning beds, gene al ban o anning beds in some coun ies
Legisla i e ac ions Coope a ion wi h officials ega ding he legisla i e, skin cance legisla ion
F on ie s in Public Heal h 04 on ie sin.o g
Bieck e al. 10.3389/ pubh.2025.1597621
TOP p inciple is o high impo ance, in which measu es a e o
be used in a hie a chical o de : Fi s , echnical measu es (e.g.,
shading); second, o ganiza ional measu es (e.g., shi ing wo king
hou s om sola UVR peak hou s); and hi d, pe sonal measu es
(e.g., clo hing, sunsc een use). The pe sonal measu es u he may
include he use o sunglasses, long clo hing and headgea ha
p o ec s agains UVR. In ega d o sunsc een, i is essen ial o
ensu e ha he p oduc p o ides p o ec ion agains bo h UVA
and UVB adia ion, is wa e p oo and has a sun p o ec ion
ac o o a leas 30 (p e e ably 50+)(12). Fu he mo e, p ima y
p e en ion o occupa ional skin cance has been demons a ed
o be a cos -effec i e app oach, s aigh o wa d o implemen and
en o ceable h ough legisla ion a bo h na ional and sup ana ional
le els (21). I has also been demons a ed ha he p o ision o
sunsc een elimina es he ba ie o access sunsc een. One po en ial
solu ion is o s o e sunsc een in a con enien loca ion, o example
on a key ob, o educe he inhibi ion h eshold o eapplying
sunsc een. Mo eo e , he applica ion o sunsc een appea s o be
mo e p e alen among ou doo wo ke s han he use o long
clo hing in he summe mon hs (20), which is one example o why
educa ion on he co ec implemen a ion o measu es acco ding o
he TOP p inciple is necessa y.
In connec ion wi h he p e- equisi es o ecogni ion, he
dis inc ion be ween occupa ional and p i a e UV exposu e was
men ioned, among o he s. I should be no ed ha i can
be challenging o de e mine he exac sou ce o exposu e
when diagnosing occupa ional skin cance . I is possible ha
p i a e exposu e, such as sunba hing, may ha e an addi ional
nega i e effec on he skin, pa icula ly when combined wi h an
exis ing occupa ional exposu e. In coun ies whe e skin cance
is ecognized as a consequence o occupa ional UV exposu e, a
decision mus be made a he ime o diagnosis as o whe he p i a e
o occupa ional exposu e plays a g ea e ole. Fu he mo e, i is
impo an o conside ha UV exposu e is cu en ly inc easing
in bo h fields (occupa ional and p i a e) due o clima e change
(22,23). In he ligh o his complexi y, a p ecise analysis o
he pa ien ’s occupa ion and a de ailed examina ion o he skin,
including accu a e s a emen s om he pa ien , is essen ial in o de
o ensu e an accu a e diagnosis. Wi h Wi lich’s o mula a p o ound
es ima ion o occupa ional UVR exposu e can be achie ed (22).
Sun sa e y campaigns can also help o imp o e sun p o ec ion
beha io bo h a wo k and in a p i a e con ex . One example o
his is he “Slip, Slop, Slap” campaign, which has been unning
in Aus alia since 1981. In 2007 i was upda ed o “Slip, Slop,
Slap, Seek, Slide” and is di ec ed a he gene al popula ion which
does no exclude he applica ion in he occupa ional en i onmen ,
bu is jus as necessa y and use ul he e (24,25). The meaning
behind his slogan is o slip on a (long-slee ed) shi , slop
on sunsc een and slap on a ha , seek shade and slide on
sunglasses, in o de o p o ec he skin and eyes agains sola
UVR (24,25). In Ge many an educa ional pa ien counseling
app oach o indi idual sun p o ec ion was de eloped and es ed
(26). The pe sonalized counseling app oach, which allows o he
componen s o be flexibly adap ed o he pa ien ’s equi emen s,
was well ecei ed by he ou doo wo ke s. Fu he mo e, i was
disco e ed ha despi e he p e alen endo semen o enhanced
sun p o ec ion me hodologies among specific occupa ional g oups,
he majo i y o sun p o ec ion p og ammes do no conside
he dis inc i e ci cums ances o hose engaged in ou doo
wo k. I is impe a i e ha his be conside ed when de eloping
enhanced sun p o ec ion s a egies (25,26). The a o emen ioned
examples illus a e he efficacy o educa ional measu es in bo h
he gene al (p i a e) en i onmen and he p o essional con ex ,
demons a ing hei capaci y o enhance sun p o ec ion beha io .
I is, he e o e, impo an ha such measu es con inue o be
de eloped, in es iga ed and p omo ed.
In his in es iga ion, he numbe o yea s exposed o UVR is
conside ed by 69.0%, he numbe o yea s in ou doo wo k by
65.5% o he esponding coun ies which ecognize skin cance
caused by UVR as an occupa ional disease. The acknowledgmen
o diffe en ypes o skin cance as occupa ional diseases a ies
conside ably be ween he esponding coun ies, wi h MM being
acknowledged in 79.3% o coun ies and SCC in 86.2%. Ob iously,
epidemiological e idence o inc eased isk o ou doo wo ke s
compa ed o he a e age popula ion exis s only o SCC, AK,
Bowen’s disease and BCC (7,27–29), i is lacking o melanoma,
e en hough some effo s ha e been made o es ablish an
associa ion (30). Howe e , he acknowledgmen o any o m o
skin cance o i s p ecu so s, such as AK and Bowen’s disease,
emains inadequa e in nume ous coun ies. Fo ou doo wo ke s
affec ed by skin cance s ha a e no ye ecognized as wo k- ela ed,
his can ha e an impac on hei ea men op ions (31,32). In
he absence o such ecogni ion, he affec ed employees migh no
be en i led o wo k- ela ed compensa ion. This can place hem a
a disad an age when i comes o co e ing he cos s o medical
ea men . To imp o e he medical ca e o ou doo wo ke s wi h
occupa ional skin cance an in ense educa ion o he au ho i ies
and heal h acili ies and s anda dized epo ing o UV- ela ed skin
cance o popula ion-based cance egis ies should be p o ided. In
addi ion, coun y specific legisla ion should be adap ed o ensu e
access o heal h se ices o all affec ed ou doo wo ke s. An
impo an Posi ion S a emen in his ega d, d awn up as a esul o
he fi s Mul i-S akeholde Summi on Occupa ional Skin Cance
(Pa is, 2019), se ou he ollowing fi e poin s o be achie ed in his
con ex (17):
1. Policymake s should imp o e he legisla i e amewo k o
p o ec ou doo wo ke s mo e effec i ely and build accessibili y
o egula sc eenings and hus ea lie ea men s. In he
Eu opean Union (EU), NMSC should be officially ecognized as
an occupa ional disease wi hin he nex legisla i e pe iod.
2. Doc o s, o he heal h p o essionals and policymake s should
wo k oge he o ensu e s anda dized EU-wide egis a ion
o NMSC.
3. Employe s should use ools o moni o exposu e le els o
UVR in he wo kplace. They shall also implemen cos -effec i e
echniques o sun-sa e beha io and ensu e egula skin cance
sc eenings o ou doo wo ke s.
4. Doc o s and o he heal h p o essionals should imp o e
epo ing o occupa ional NMSC (including AK).
5. Pa ien ad ocacy g oups, doc o s and o he heal h p o essionals
as well as employe s should collabo a e o p omo e skin cance
p e en ion and sun-sa e wo king p ac ices and o add ess he
unme needs o e i ed ou doo wo ke s wi h pe sis ing NMSC.
The achie emen o hese fi e impo an goals which a e also
pa o he Global Call o Ac ion (33) could p o ide a be e
F on ie s in Public Heal h 05 on ie sin.o g

Bieck e al. 10.3389/ pubh.2025.1597621
si ua ion o ou doo wo ke s ega ding he p e en ion, ea men ,
and acknowledgmen o occupa ional skin cance .
Wi h ega d o he cosme ic use o anning beds, he esul s
indica e ha legal ins umen s o con olling his a e a ailable in
<50% o he esponding coun ies. Ma hes e al. (8) compa ed
he legal egula ions on anning bed ad e ising and in o ma ion
equi emen s in No h Ame ica, Aus alia/New Zealand and
Eu ope. Thei findings e ealed he e ogenei y o 131 legisla i e
uni s, wi h 81 (60%) ha ing some o m o legal egula ion.
The au ho s ecommend an in e na ional exchange in o de o
de elop global s anda ds on he egula o y amewo k (8). I is
a his junc u e ha he WHO and ILDS a e especially in ol ed.
Howe e , he esul s on ecei ing in o ma ion om he WHO
conce ning hei wo k on he isk o using anning beds eached
only 21.2% o he esponding coun ies which is an un o una ely
low numbe . The easons o his a e unclea and should be
documen ed in o de o add ess his gap in knowledge and
imp o e he a ailable in o ma ion abou he isks associa ed wi h
anning beds. In o de o educe he incidence o skin cance
i is necessa y o limi he exposu e o he popula ion o UVR
om anning beds. I is he e o e necessa y o educa e—especially
young—people abou he isks associa ed wi h UV exposu e and
he impo ance o UV p o ec ion, gi en ha hey ep esen he
p ima y a ge o he sunbed indus y (8). This is p oblema ic
because inc eased UV exposu e a a young age can significan ly
ele a e he isk o de eloping skin cance , pa icula ly MM and
BCC (6). Fu he mo e, he use o anning beds o cosme ic
pu poses should be s ic ly egula ed by he go e nmen , o be e ,
p ohibi ed, which is al eady he case in some coun ies (see
Table 1), pa icula ly o adolescen s and child en. This necessi a es
he implemen a ion o comp ehensi e educa ional ini ia i es and
in e na ional discou se o acili a e he in oduc ion o sui able
measu es. I would also be easible o impose condi ions on
he sunbed indus y, which is cu en ly ocusing i s ad e ising
p ima ily on young people. An obliga ion o p o ide in o ma ion
concu en ly would be a iable op ion, bu his could appea o be
challenging o implemen due o he in ol ed economic in e es .
Ne e heless, i is incumben upon he se ice p o ide o ensu e
ha he cus ome is ully in o med, a esponsibili y ha mus be
defined by legal egula ions. Consequen ly, educa ion a an ea ly
age, e. g. in school, is o pa amoun impo ance o ensu e ha
young people a e awa e o sun sa e y and he isks associa ed
wi h he use o anning beds. Also, Suppa e al. (34) in es iga ed
he p e alence and de e minan s o using anning beds among 30
membe coun ies o Eu omelanoma, a Eu opean campaign o
p ima y and seconda y skin cance p e en ion (34). As expec ed,
hey ound a lowe p e alence han in p e ious epo s, as he da a
came om a campaign o skin cance sc eening. P e alence a es
we e highe in no he n coun ies wi h low le els o sunligh , wi h
he excep ion o I aly and Spain. Age and gende we e iden ified
as impo an de e minan s. Young adul s and women we e he
mos equen use s o anning beds. The highes p e alence a es
o young adul s using anning beds we e ound in he Bal ic
coun ies and among adolescen s in Scandina ian coun ies (34).
This emphasizes once again he need o p e en ion wo k and
legal egula ions, pa icula ly in adolescen s. In he ligh o he s ill
cul u ally and socially ecognized aes he ic ideal o anned skin, i
mus be ques ioned whe he al e na i es o UV exposu e a e mo e
app op ia e o anning he skin. New on e al. (35) in es iga ed
popula sel - anning p oduc s in his ega d and ound ha hey
o en con ain con ac alle gens (e.g. p opylene glycol, linalool,
ag ances, e c.). Whils hese p oduc s may ep esen an al e na i e
o UVR, hey ha bo he isk o alle gic eac ions (35).
Fo una ely, he numbe o coun ies wi h cu en pa icipa ion
in ac i i ies on UVR p o ec ion and/o agains he use o anning
beds, is high (72.7%). P e ious mul icomponen in e en ion
s udies ha e demons a ed he impac o knowledge and awa eness
on sun p o ec i e beha io in ou doo wo ke s (36,37). Howe e ,
g ea e commi men om employe s and egula ion by he heal h
and sa e y au ho i ies is ecommended o ensu e consis en and
effec i e implemen a ion o p o ec i e measu es and o p omo e
long- e m beha io change ha educes he isks o UVR exposu e
in he wo kplace (37). As illus a ed in Table 1, he execu ion o
campaigns and public ela ions ini ia i es can be implemen ed e y
diffe en ly. The ac ha he e a e diffe ences be ween sexes and
age g oups in he field o inc eased isk o skin cance —women
and young adul s o anning beds (34), men and olde age g oups
o occupa ional skin disease (7)—also shows ha educa ional
measu es a e needed o all sexes and age g oups o p omo e gene al
awa eness o sun sa e y and skin p o ec ion. I is ele an o once
again ci e he success ul “Slip, Slap, Slop, Seek, Slide” campaign in
Aus alia, which e en combines i s slogan wi h a ca chy song ha
calls o people o beha e sun sma when hey a e ou side, whe he
a wo k o in a p i a e con ex (24). The Aus alian Cance Council
iden ified an effec i e s a egy o aising public awa eness abou
sun sa e y and p omo ing simple, effec i e me hods o p o ec ing
onesel om sola UVR. Due o he SunSma p og amme he e
has been a cul u al ans o ma ion owa d sun p o ec ion no ms,
schools and wo kplaces ha e adop ed sun p o ec ion policies as
a esul o his ini ia i e (38). I is simila ly possible o sun
p o ec ion campaigns o achie e popula i y in o he coun ies
i hey a e dissemina ed in an app op ia e manne . Du ing he
launch o “Slip Slop Slap” in 1981, he cen al dis ibu ion medium
o ideos was ele ision. In he cu en e a, i is easible o
dissemina e such ini ia i es ia he In e ne , o ins ance, h ough
he placemen o ad e isemen s adjacen o ideo con en , e. g. like
i is equen ly he case wi h YouTube. In Ge many a campaign has
been ini ia ed wi h a specific ocus on skin heal h in occupa ional
con ex s en i led “hau und job” (“skin and job”). The campaign
websi e con ains in o ma ion abou occupa ional skin diseases,
p e en ion, ea men and epo ing, as well as download ma e ial
and links o u he esou ces (39). This campaign is only one
pa o he Eu opean ini ia i e “Heal hy Skin @ Wo k” o he
Eu opean Academy o De ma ology and Vene ology (EADV) wi h
he slogan “You skin— he mos impo an 2 m2o you li e” (40).
Ano he example is he a o emen ioned Eu omelanoma, which
was ounded in 1999. This o ganiza ion ocuses on he gene al
public h ough i s websi e and an annual campaign, d awing
a en ion o seconda y p e en ion, sc eening and ea men op ions
o skin cance in addi ion o p ima y p e en ion (41). Fo
de ma ologis s and o he heal h p o essionals, scien ific a icles a e
egula ly published and s udies a e ca ied ou wi h he help o
he membe s a es, e.g., he compa ison o anning bed use in
diffe en coun ies (34,41). As a hi d a ge g oup, Eu omelanoma
add esses go e nmen s by o ganizing special e en s o highligh
p oblems and secu e poli ical suppo (41).
F on ie s in Public Heal h 06 on ie sin.o g
Bieck e al. 10.3389/ pubh.2025.1597621
One limi a ion o his s udy is he ela i ely low numbe o
coun ies ha esponded o he su ey. Gi en ha only 66 o he
104 membe coun ies o he ILDS esponded, i would be wo h
conside ing how o encou age g ea e pa icipa ion om coun ies
in he u u e. Rega ding he manual pooling o cases in which mo e
han one pe son answe ed o one coun y, one limi a ion is ha
human e o can occu when colla ing and in e p e ing he da a.
Con adic o y answe s could be subjec i ely assessed, which migh
lead o dis o ions. In addi ion, he manual p ocess can impai he
ep oducibili y. Al hough he e was a manual plausibili y check, i
canno be uled ou ha inaccu acies occu ed due o subjec i e
judgemen s. Howe e , i canno be assumed ha he significance
o he esul s is es ic ed by hese limi a ions, gi en ha possible
disc epancies a e minimal and unlikely o ha e a majo impac on
he findings.
Fu he esea ch could build on he p esen findings by
linking he ques ionnai e esul s wi h na ional da a on skin cance
incidence and mo ali y a es. A comp ehensi e analysis could
p o ide insigh s in o he po en ial influence o dispa i ies in
epo ing s uc u es, p ac ices on he documen a ion and ou comes
o occupa ional skin cance cases. Fu he mo e, i would be
wo hwhile o explo e whe he egula o y measu es, such as he
egula ion o anning bed use o he o mal ecogni ion o skin
cance as an occupa ional disease, ha e an impac on epo ed
skin cance a es ac oss coun ies. These di ec ions offe p omising
oppo uni ies o u he in es iga ion and could con ibu e o a
deepe unde s anding o sys emic ac o s influencing occupa ional
skin cance epo ing and p e en ion.
Conclusion
In he ligh o he esul s o his s udy, i is ecommended
ha he ecogni ion o occupa ional skin cance as an occupa ional
disease should be econside ed and implemen ed in many coun ies
o ensu e adequa e ca e o affec ed ou doo wo ke s. Wi h ega d
o he a ious ypes o skin cance , he links be ween ou doo
wo k and ypes o skin cance , including he p ecu so s (AK,
Bowen’s disease), should be disclosed and aken in o accoun . I is
ecommended ha he in e na ional exchange ha is al eady aking
place a he Mul i-S akeholde Summi on Occupa ional Skin
Cance should be u he p omo ed in o de o make he poli ical
au ho i ies awa e o he p oblem and he need o ecogni ion (42–
44). In e ms o p e en ion, awa eness campaigns should no only
a ge he gene al popula ion, bu should also ocus on UV exposu e
in he wo kplace and i s effec s on he skin. The examples gi en
in his s udy show ha he e a e a ious effec i e op ions he e.
T aining and awa eness- aising measu es o employees and he
coope a ion o employe s, o ins ance h ough he p o ision o
sunsc eens, should also be p omo ed in his ega d. I is impo an
o implemen sun p o ec ion measu es, o which eminde s can
be es ablished as means o ensu ing compliance. In addi ion o
p ima y p e en ion in ou doo wo ke s, i is necessa y o make
a ailable o his high- isk g oup seconda y and e ia y p e en ion,
and possible con ac poin s in he case o diagnosed o suspec ed
skin cance .
In he ligh o he legal egula ions on p o ec ion om a ificial
UVR in anning beds, s ic e guidelines should be implemen ed,
pa icula ly o adolescen s and, ideally, also o (young) adul s
as well. The sunbed indus y and ad e ise s should be subjec
o equi emen s ha include comp ehensi e in o ma ion o
cus ome s in addi ion o ad e ising. Ano he po en ial egula o y
measu e would be he es ablishmen o guidelines o using
anning beds wi h ega d o equency, du a ion and he maximum
ecommended adia ion dose, which should be egula ly e iewed
and upda ed. I should also be de e mined whe he al e na i e
me hods o achie e a anned appea ance, such as sel - anning
lo ions, a e mo e app op ia e in his con ex , possible con ac
alle gies should be conside ed.
In bo h desc ibed scena ios, he implemen a ion o p e en i e
measu es o educe UV exposu e and he p omo ion o inc eased
educa ion and legal egula ion a e o cen al impo ance. In
conclusion, he esul s o he p esen ed s udy indica e a p essing
need o u he ac ion in e ms o skin cance p e en ion a
a ious le els, spanning no only he leisu e bu especially he
occupa ional sec o . This is o significan impo ance gi en he
ising p e alence o skin cance as a global public heal h conce n as
his disease disp opo iona ely affec s high- isk g oups, including
ou doo wo ke s, and people wi h a p ocli i y o unp o ec ed UVR
exposu e, such as anning bed use.
Da a a ailabili y s a emen
The o iginal con ibu ions p esen ed in he s udy a e included
in he a icle/supplemen a y ma e ial, u he inqui ies can be
di ec ed o he co esponding au ho .
Au ho con ibu ions
CB: Me hodology, Visualiza ion, Da a cu a ion, In es iga ion,
Concep ualiza ion, Valida ion, P ojec adminis a ion, Fo mal
analysis, W i ing – o iginal d a . AA: W i ing – o iginal
d a , Valida ion, Fo mal analysis. SJ: Concep ualiza ion,
Resou ces, W i ing – e iew & edi ing, Supe ision, Me hodology,
Fo mal analysis.
Funding
The au ho (s) decla e ha no financial suppo was ecei ed o
he esea ch and/o publica ion o his a icle.
Acknowledgmen s
The au ho s would like o acknowledge he suppo om he
In e na ional League o De ma ological Socie ies (ILDS), especially
Miss Homa Chuku, in conduc ing he su ey.
Conflic o in e es
The au ho s decla e ha he esea ch was conduc ed in he
absence o any comme cial o financial ela ionships ha could be
cons ued as a po en ial conflic o in e es .
F on ie s in Public Heal h 07 on ie sin.o g
Bieck e al. 10.3389/ pubh.2025.1597621
The e iewe CS decla ed a pas co-au ho ship wi h he
au ho CB.
Gene a i e AI s a emen
The au ho (s) decla e ha no Gen AI was used in he c ea ion
o his manusc ip .
Publishe ’s no e
All claims exp essed in his a icle a e solely hose o he
au ho s and do no necessa ily ep esen hose o hei affilia ed
o ganiza ions, o hose o he publishe , he edi o s and he
e iewe s. Any p oduc ha may be e alua ed in his a icle, o
claim ha may be made by i s manu ac u e , is no gua an eed o
endo sed by he publishe .
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