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Little Known Risk Factors for Skin Cancer

By: Cynthia Griffith, MPAS, PA-C
  • Vocation – welders, pilots, flight attendants have an increased risk of skin cancer. A Danish study found that welders have an increased risk of basal cell carcinoma and actinic keratosis (a precursor to squamous cell carcinoma) on the neck[1].  This is likely due to the ultraviolet radiation produced by the arc welding process.  Pilots and flight attendants also have an increased risk for melanoma and non-melanoma skin cancer. In a plane, the ultraviolet radiation transmitted by the sun is closer. Pilots’ risk of melanoma is two times higher than the general population[2].
  • Anyone who has had a history of radiation for cancer or, in older patients, history of radiation for acne treatment has an increased risk for skin cancer within the area that was irradiated. Radiation, especially in the first three decades of life, increases the risk for skin cancer in the area that was treated.
  • Medications like hydrochlorothiazide and voriconazole are associated with increased risk of skin cancer. Cancer, in this case, is associated with cumulative doses of these so increased exposure over time is what is most concerning. If a person is on one of these medications and they develop skin cancer, they should be switched to a different medication.
  • Anyone who is immunosuppressed has an increased risk of skin cancer. An intact immune system helps protect against skin cancer so people who have decreased immune systems, for example, people who have had solid organ transplants or patients on immunosuppressants to treat autoimmune diseases like psoriasis need yearly skin examinations to monitor for development of skin cancer.
  • Blistering sunburns before age 18 predisposes people to skin cancer, specifically basal cell carcinomas in the area where they had the blisters. When doing self-skin examinations pay special attention to new spots in these areas (ie. Hairline parts, backs of the ears, shoulders, tops of the feet).
  • History of trauma or burns. Skin cancer can develop within a site of scarring like a chemotherapy port scar, a burn scar, or a site of an IV stick. Be concerned about any changing scars or sites of ulceration within a scar.

[1] K. N. Heltoft,1 R. M. Slagor,1
T. Agner,2
and J. P. Bonde,
Metal arc welding and the risk of skin cancer. Int Arch Occup Environ Health.
2017; 90(8): 873–881.

[2] Buja A, Lange
JH, Perissinotto E, et al. Cancer incidence among male military and civil
pilots and flight attendants: an analysis on published data. Toxicol Ind
Health. 2005;21:273-282.

See Cynthia Griffith, MPAS, PA-C speak at a 2020 Skin, Bones, Hearts & Private Parts event in Destin • Pensacola Beach • San Antonio • Las Vegas