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Original research
Risk assessment of occupational skin cancer among outdoor workers in southern Spain: local pilot study
  1. Magdalena de Troya Martín1,
  2. Sierra Aguilar2,
  3. José Aguilera-Arjona3,
  4. Francisco Rivas-Ruiz4,
  5. Alba Rodríguez-Martínez4,
  6. Guillermo de Castro-Maqueda5,6,
  7. Jacobo Cambil-Martín6,
  8. Victoria de Gálvez-Aranda7,
  9. Nuria Blázquez-Sánchez1
  1. 1 Department of Dermatology, Sun Coast Hospital, Marbella, Spain
  2. 2 Occupational Risk Prevention Service, Fuengirola City Council, Fuengirola, Spain
  3. 3 Photobiological Dermatology Laboratory, Medical Research Centre, Department of Medicine and Dermatology, University of Malaga, Malaga, Spain
  4. 4 Research Unit, Sun Coast Hospital, Marbella, Spain
  5. 5 Physical Education Department, Education Science Faculty, University of Cadiz, Cadiz, Spain
  6. 6 Nursing Department, Health Science Faculty, University of Granada, Granada, Spain
  7. 7 Department of Medicine and Dermatology, University of Malaga, Malaga, Spain
  1. Correspondence to Dr Magdalena de Troya Martín, Department of Dermatology, Sun Coast Hospital, Marbella, Andalucía, Spain; magdalenatroya{at}


Objective Overexposure to ultraviolet (UV) radiation is the main preventable cause of skin cancer. Outdoor workers, exposed to the sun for many hours throughout their working lives, are at special risk. The aim of this study is to determine occupational photoexposure and photoprotection among outdoor workers employed by a municipality in southern Spain.

Methods Cross-sectional descriptive study focusing on outdoor workers employed by the municipality of Fuengirola (in areas such as construction, gardening, urban cleaning and beach maintenance). The participants were monitored by personal dosimetry, participated in a dermatological check-up and answered a validated questionnaire (CHACES) on their habits, attitudes and knowledge related to sun exposure.

Results The median effective erythema dose of exposure to solar UV radiation during the working day (n=20) was 379.4 J/m2, equivalent to 3.8 standard erythema doses, almost 3 times higher than the recommended limits for an 8-hour workday. Skin examination (n=128) revealed the presence of actinic lentigines (79.7%), actinic keratoses (8.6%) and skin cancer (3.9%). The CHACES questionnaire (n=128) revealed a sunburn rate of 50.0%. Photoprotection practices were markedly deficient: only 16.7% of the survey respondents sought protection in the shade, 20.3% avoided exposure during the peak exposure hours and 33.1% applied sunscreen.

Conclusions This is the first study to evaluate UV radiation exposure, occupational sun protection practices, sunburn and actinic injuries of different outdoor workers in one of the sunniest regions of Spain and underlines the need for effective interventions to protect outdoor workers’ health.

  • occupational health
  • environmental exposure
  • dermatology
  • occupational health services
  • radiation, nonionizing

Data availability statement

Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.

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  • Contributors Concept and design: MdTM and NB-S. Data collection, analyses and interpretation: MdTM, SA, JA, FR-R, AR, JC-M, VdG-A and NB-S. Drafting of the manuscript: MdTM, FR-R, AR and NB-S. Supervision, critical revision and approval of the manuscript: all authors. MdTM acts as guarantor of this work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests The authors have no conflict of interest to declare.

  • Ethical approval Approval for this study was obtained from the Sun Coast Research Ethics Committee (April 2019; No. 002_abr19_PI2). The study data were recorded anonymously, in strict accordance with all applicable laws and regulations on data protection and confidentiality. All participants signed an informed consent form before starting the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.