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Journal of the American Academy of Dermatology
Volume 39, n° 5
pages 712-720 (novembre 1998)
Doi : 10.1016/S0190-9622(98)70043-X
accepted : 26 June 1998
Occupationally related tumors in tar refinery workers
 

Stephan Letzel, MDa, Hans Drexler, MDb
Erlangen and Aachen, Germany 

Abstract

Background: The study comprised 606 workers with tar-induced dermatosis employed in a German tar refinery. During the period from 1946 to 1996 they were recognized as having an occupational disease. Objective: The aim of this study was to characterize the histologic findings and the localization of the occupational dermatosis and to determine the latency period of the carcinomas from the beginning of exposure in the tar refinery to the first occurrence of malignant skin tumors. Furthermore, the study aimed to check whether other skin changes were frequently diagnosed in addition to known tar-induced tumors. Methods: The data were collected retrospectively from the documents of the Employer’s Liability Insurance Association. Results: Surgical removal of 4754 skin tumors was documented up to the end of 1996 in the study. In 90% of cases the histologic diagnosis was confirmed. Among other conditions, this yielded 2490 precancerous stages, 380 squamous cell carcinomas, 218 basal cell carcinomas, and 182 keratoacanthomas. The skin tumors were found mainly in the facial area, as well as on the forearms and hands. Latency from the first exposure in the tar refinery until manifestation of tar-induced dermatosis covered a period of 57 years. Conclusion: In comparison to the general population, the ratio of squamous cell to basal cell carcinomas was shifted toward the squamous cell carcinomas (1.7:1). Sunlight is known to be a cofactor in the pathogenesis of keratosis, squamous cell carcinomas, and basal cell carcinomas. However, the difference in location of these tumors shows that the role sunlight plays in the pathogenesis of precancerous lesions and squamous cell carcinomas may be overvalued. The latency period from the beginning of exposure to the manifestation of squamous cell carcinomas could not be evaluated because of an intervention bias as a result of preventive excisions of precancerous lesions. The frequent occurrence of keratoacanthomas (in 18.7% of the workers) and the early age at which this disease became manifest relative to the general population (median, 55 years) indicate that employment in a tar refinery can primarily or secondarily cause keratoacanthomas. (J Am Acad Dermatol 1998;39:712-20.)

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 From the Institute and Out-patient Clinic for Occupational, Social and Environmental Medicine, University of Erlangen-Nuremberg,a and the Department of Occupational Medicine, Technical University of Aachen. b
 Supported by the Berufsgenossenschaft der chemischen Industrie, Cologne, Germany.
 Reprint requests: Privatdozent Dr med Dipl-Ing Stephan Letzel, Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin der Universität Erlangen-Nürnberg, Schillerstraße 25 und 29, 91054 Erlangen, Germany. E-mail: Stephan.Letzel@rzmail.uni-erlangen.de
 0190-9622/98/$5.00 + 0   16/1/92726

*  * According to the “Sozialgesetzbuch VII” in Germany [§ 9 (1) SGB VII] (Federal Insurance Code), occupational diseases are irregular conditions of the body and mind, which, according to medical science, are caused by particular influences to which certain groups of persons are subjected through their work to a much greater degree than the rest of the population. The only adverse effects on health that can be considered an occupational disease in Germany are those which the government has listed by statutory order in the appendix to the currently valid Berufkrankheitenverordnung. However, with the admission of a disease in the list, only the general character of an occupational disease is recognized. The duty to compensate presupposes that in each individual case the essential cause of the disease can be found in all probability in the occupational activity. According to the “Sozialgesetzbuch VII” [§ 9 (2) SGB VII], however, a disease not listed in the appendix also can be compensated like an occupational disease. The prerequisite is the “proof of an abundance of similar health impairments and the long-term monitoring of such symptoms in order to be able to conclude with certainty that the cause of the disease lies in hazardous work.” The current appendix to the Berufskrankheitenverordnung in Germany lists 67 diseases or groups of diseases as being worthy of compensation.Modified according to 11
*  *BK-Nr. 5102: “Hautkrebs oder zur Krebsbildung neigende Hautveränderungen durch Ruß, Rohparaffin, Teer, Anthrazen, Pech oder ähnliche Stoffe.”
*  *This patient (born 1905, died 1977) died of metastatic carcinoma of the large intestine and had been employed in the tar refinery from 1928 to 1962; the first tar-induced skin tumor appeared in 1938.
*  *Some persons of the collective had their first tar-induced tumor before the observation period.Letzel and Drexler
*  * Hundeiker M. Keratoakanthoma. Presented at Sofia Dermatological Days, Sofia, Bulgaria, Nov 3-5, 1994.


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