Abstract
Background: The relationship between occupational sun exposure and melanoma risk is complex and multifaceted, with existing evidence yielding contradictory findings. Unlike Non-Melanoma Skin Cancer (NMSC), for which occupational sun exposure is a well-established risk factor, the link with cutaneous melanoma remains contentious. Objectives: This study aimed to evaluate whether, in a cohort of patients with cutaneous melanoma, an association existed between occupational sun exposure and melanoma, specifically with histotype, site of occurrence, and Breslow index. Methods: This is a retrospective cohort analysis conducted to evaluate whether occupational sun exposure constitutes a risk factor for the development of cutaneous melanoma in patients diagnosed between January 2005 and October 2023 at the Dermatology Unit, Azienda USL Toscana Centro, Florence. Occupational ultraviolet (UV) exposure was examined by classifying each participant's job into categories based on solar UV exposure levels-outdoor (e.g., agriculture and construction roles), mixed indoor/outdoor (e.g., trades and public safety professions), and indoor settings (e.g., office-based work). Results: A final total of 1417 patients were analyzed. Occupational categorization revealed that 1171 patients (82.64%) were classified as non-occupationally exposed (indoor), while 246 (17.36%) were occupationally exposed to solar UV radiation (including 14.82% mixed indoor/outdoor and 2.54% outdoor workers). A significant association was observed between occupational sun exposure and lentigo maligna, which was more prevalent among exposed workers and even more so in the outdoor subgroup. Anatomical site distribution exhibited a significant association with occupational sun exposure. Indeed occupationally exposed individuals showed a higher prevalence of melanomas in the head and neck region, a distribution pattern particularly evident among outdoor workers, suggesting that these sites may be more susceptible to chronic sun exposure in outdoor and mixed occupations. Moreover, a significant association was found between occupational exposure and Breslow thickness, with exposed workers presenting with thicker melanomas at diagnosis, suggesting more advanced disease. Conclusions: The finding of this study may reflect variations in occupational sun exposure patterns and warrants further investigation into protective measures and early-detection strategies tailored to occupational groups.