Current status of national regulations on tanning bed use and workers' protection from solar ultraviolet radiation: results from a global International League of Dermatological Societies (ILDS) questionnaire study

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 . Re e ences 1. Gag O, Dinu , S, Manea H, Ma co ici I, Pînza u I, Popo ici R, e al. UVA/UVB i adia ion exe s a dis inc pho o oxic effec on human ke a inocy es compa ed o human malignan melanoma cells. Li e. (2023) 13:1144. doi: 10.3390/li e13051144 2. Bundesam ü S ahlenschu z (BA S). Was is UV-S ahlung? (2024). A ailable online a : h ps://www.b s.de/DE/ hemen/op /u /ein ueh ung/ein ueh ung_node. h ml (Accessed Ma ch 19, 2025). 3. Paulo MS, Adam B, Akagwu C, Akpa ibo I, Al-Ri ai RH, Baz a shan S, e al. WHO/ILO wo k- ela ed bu den o disease and inju y: P o ocol o sys ema ic e iews o occupa ional exposu e o sola ul a iole adia ion and o he effec o occupa ional exposu e o sola ul a iole adia ion on melanoma and non-melanoma skin cance . En i on In . (2019) 126:804–15. doi: 10.1016/j.en in .2018.09.039 4. 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