By:Thandiwe Kubere

World Health Organization (WHO) and the International Labour Organization (ILO) revealed that, nearly 1 in 3 deaths from non-melanoma skin cancer is caused by working under the sun. The research released in Environment International finds that outdoor workers carry a large and increasing burden of non-melanoma skin cancer and calls for action to prevent this serious workplace hazard and the loss of workers’ lives it causes. This information is crucial in countries like Lesotho, where agriculture and other activities, which normally require people to work in the sun, is actively practiced

According to the joint estimates, 1.6 billion people of working age (15 years or older) were exposed to solar ultraviolet radiation while working outdoors in 2019, equivalent to 28% of all working-age people. In 2019 alone, almost 19 000 people in 183 countries died from non-melanoma skin cancer due to having worked outdoors in the sun. The majority (65%) were male.

Non-melanoma skin cancer refers to all the types of cancer that occur in the skin that are not melanoma- a type of cancer that develops from the pigment-producing cells known as melanocytes. Melanomas typically occur in the skin, but may rarely occur in the mouth, intestines, or eye. Several types of skin cancer fall within the broader category of non-melanoma skin cancer.

Non-melanoma skin cancers slowly develops in the upper layers of the skin. The term ‘non-melanoma’ distinguishes these more common kinds of skin cancers from the less common skin cancers known as melanoma, which spreads faster in the body.

These cancers are associated with cell damage due to prolonged or chronic exposure to ultraviolet (UV) rays. Moreover, people with light-coloured skin that burns easily are at higher risk, especially if they or someone in their family had skin cancer in the past. Treatment for non-melanoma skin cancer usually involves surgery to remove the cancer cells. There are many ways to treat skin cancer, depending on its type and how advanced it is. Surgery is the most frequently used approach to managing skin cancers.

“Unprotected exposure to solar ultraviolet radiation at work is a major cause of occupational skin cancer,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “But there are effective solutions to protect workers from the sun’s harmful rays, and prevent their deadly effects.”

The estimates establish occupational exposure to solar ultraviolet radiation as the work-related risk factor with the third highest attributable burden of cancer deaths globally. Between 2000 and 2019, skin cancer deaths attributable to occupational exposure to sunlight almost doubled (increasing by 88% from 10 088 deaths in 2000 to 18 960 deaths in 2019).

According to ILO Director-General, Gilbert Houngbo, a safe and healthy working environment is a fundamental right at work, and death caused by unprotected exposure to solar ultraviolet radiation while working is largely preventable through cost-effective measures. It is urgent that governments, employers and their workforces work together in a framework of well-defined rights, responsibilities and duties to reduce the occupational risk of UV exposure. This can save thousands of lives every year.

WHO has therefore called for more action to protect employees from hazardous outdoor activities which expose them to sunlight. As skin cancer develops after years or even decades of exposure, workers must be protected from solar ultraviolet radiation at work from a young working age onwards. The study enlightens that governments should establish, implement and enforce policies and regulations that protect outdoor workers from sun-induced skin cancer. This can be achieved by providing shade, shifting working hours away from the solar noon, providing education and training, and equipping people with sunscreen and personal protective clothing (such as broad-brimmed hat, long-sleeved shirts and long trousers). It states that protective measures should be implemented when the ultraviolet index, a scale rating the amount of skin-damaging ultraviolet radiation, is 3 or higher.

WHO, ILO, the World Meteorological Organization and the United Nations Environment Programme recently launched the Sun Smart Global UV App that outdoor workers can use to estimate their exposure to solar ultraviolet radiation.

In addition, measures to reduce skin cancer risks include raising workers’ awareness of when occupational exposure to solar ultraviolet radiation occurs and that it causes skin cancer, and by providing services and programmes to detect early signs of skin cancer.

These estimates are based on a recent WHO report of a systematic review and meta-analysis, which highlighted that occupational exposure to solar ultraviolet radiation is associated with an estimated 60% increased risk of developing non-melanoma skin cancer.

Furthermore, although skin cancer is less common in Africa, Africans still suffer from non-melanoma skin cancer. According to a study, skin cancers, affecting people of all ages and races, are the most prevalent cancer type. In South Africa, elevated sun exposure increases the risk of skin cancer among residents.

The incidence of both non-melanoma and melanoma skin cancers has been increasing over the past decades, and WHO estimates that a 10 % decrease in ozone levels will result in an additional 300 000 non-melanoma and 4 500 melanoma skin cancer cases globally. However, the incidence of non-melanoma skin cancer is lower in Africans than in Caucasians.

Ultraviolet (UV) light is the most common cause of non-melanoma skin cancer. It comes from the sun and is used in sunbeds. Non-melanoma skin cancer is more common in older people, but younger people can also get it.

One is also more likely to get non-melanoma skin cancer if they have: pale skin that burns easily in the sun, a large number of freckles or moles, had a lot of sun exposure and has had sunburn a lot in the past, used sunbeds a lot, a family history of skin cancer or if one had skin cancer before. Additionally, people with brown or black skin have lower chances of getting non-melanoma skin cancer, but can still get it.

There are ways of lowering chances of skin cancer. They include: staying safe in the sun by wearing hats and regularly applying sun screen with a sun protection factor (SPF) of at least 30 and at least 4-star UVA protection, staying out of the sun during the hottest part of the day, keeping arms and legs covered, wearing a wide-brimmed hat and sunglasses that provide protection against ultraviolet (UV) rays. It is also important to make sure babies and children are protected from the sun since their skin is much more sensitive than adult skin.

National Health Service (NHS) declared symptoms of non-melanoma skin cancer can vary, but they often include the following: A small, raised bump that is shiny or pearly, sores that do not heal, a wart-like growth that might bleed or crust over, a hard lump on the skin, a flat sore covered in a crust of scales, a hard, itchy lip patch that might erupt into an open sore, a painful or rough area inside the mouth, a raised spot or wart-like sore on the genitalia, the anus, or both.

According to NHS, these symptoms can occur anywhere on the skin, but they are most common in areas exposed to the sun, such as the head, face, ears, neck, shoulders, back, hands, and lower legs. The growths or patches can vary in colour, size, and texture. And people are advised to see a doctor when they notice any of these symptoms, especially a growth on the skin which seems to get bigger and has changed colour or texture, or a growth or area of skin that hurts, itches, bleeds, crusts, or scabs for more than 4 weeks. Early detection of skin cancer can make it easier to treat.