Cent Eur J Public Health 2015, 23(4):275-285 | DOI: 10.21101/cejph.a4075

Climatic Factors and Epidemiologic Characteristics of Head and Neck Skin Malignancies in Osijek Baranja County, Croatia

Želimir Orkić1,2, Dinko Puntarić2, Domagoj Vidosavljević2, Ida Puntarić3, Eda Puntarić4, Vlatka Gvozdić5, Dijana Mayer6, Marina Vidosavljević7, Andrijana Muller Vranješ2
1 Department of Surgery, University Hospital Centre Osijek, Osijek, Croatia
2 Faculty Of Medicine, J. J. Strossmayer University of Osijek, Osijek, Croatia
3 Institute for Emergency Medicine of Zagreb County, Velika Gorica, Croatia
4 Biology Department, Faculty of Science, Zagreb, Croatia
5 Department of Chemistry, J. J. Strossmayer University of Osijek, Osijek, Croatia
6 Croatian Institute for Public Health, Zagreb, Croatia
7 County General Hospital, Vinkovci, Croatia

Aim: The aim of this study was to investigate and compare the incidence and epidemiological characteristics of head and/or neck skin malignancies in Osijek-Baranja County, Croatia, and to connect them with relative climatic indicators such as the number and intensity of sunny and cloudy days over a longer period of time.

Methods: The study included patients from Osijek Baranja County with confirmed pathohistological diagnosis of the head and/or neck malignancies from January 1, 2004 to December 31, 2012. The patients were analyzed according to gender, age, residence, occupation, type and location of the neoplasm, and hair and eye colour. The analysis of climatic elements (mean monthly and annual cloudiness values, mean monthly and annual sum values of sunny days) for a period of 50 years (1961-2011) based on the data of the Croatian Meteorological and Hydrological Service for the investigated area was performed.

Results: The study included a total of 2,952 patients: 1,487 (50.4%) males and 1,465 (49.6%) females, representing the estimated annual incidence of 104/100,000. The mean age was 72 years. The patients were mostly from rural areas, 1,952 (66.2%); 2,137 (72.4%) worked outdoors: 907 farmers (42.4%) and 889 construction workers (41.6%). Given the type of neoplasm, the most common was a basal cell cancer (BCC) in 2,160 patients (73.2%). Malignant melanoma was found in 93 patients (3.1%). The most common localizations were face (839 cases, 28.7%) and nose (643 cases, 22.0%). Males had a significantly higher number of planocellular malignancies - 341 (56.6%) than females - 262 (43.4%) (p=0.005). The median age of the patients was 67 years. There were no significant differences in types of malignancies, place of residence, workplace, or occupation (with respect to working outdoors or indoors). It has been shown that the ears and lips are significantly more affected by squamous cell malignancies (p=0.039 and p<0.001) compared to the neck, eye and head with malignant melanoma (p=0.004, p<0.001, and p=0.026) and the nose where basal cell neoplasms (p=0.002) prevail. There were no significant differences in the type and frequency of malignant neoplasms in relation to hair and eye colour of the patients. The last 50 years in Osijek-Baranja County have seen a declining trend in the number of cloudy days and upward trend in the mean annual sum of sunny days. When compared, the increase in sunny days results in a higher number of patients suffering from malignant melanoma (ρ=0.695, p=0.038).

Conclusion: It is obvious that malignant neoplasms of the skin, head and neck occur after decades of exposure, and as a cumulative effect of exposure to risk factors. A direct exposure to sun seems to play an important role, especially with regard to melanoma. Nevertheless, further research is needed.

Keywords: malignant neoplasms of the skin, head and neck, epidemiology, intensity of solar radiation

Received: August 20, 2014; Revised: April 6, 2015; Accepted: April 6, 2015; Published: December 30, 2015  Show citation

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Orkić Ž, Puntarić D, Vidosavljević D, Puntarić I, Puntarić E, Gvozdić V, et al.. Climatic Factors and Epidemiologic Characteristics of Head and Neck Skin Malignancies in Osijek Baranja County, Croatia. Cent Eur J Public Health. 2015;23(4):275-285. doi: 10.21101/cejph.a4075. PubMed PMID: 26841139.
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References

  1. Lucas R, McMichaelT, SmithW,Armstrong B. Solar ultraviolet radiation: global burden of disease from solar ultraviolet radiation. Environmental burden of disease series, no. 13. Geneva: WHO; 2006.
  2. Diffey BL. Stratospheric ozone depletion and the risk of nonmelanoma skin cancer in a British population. Phys Med Biol. 1992 Dec;37(12):2267-79. Go to original source...
  3. Vanicek K, Frei T, Litynska Z, SchmalwieserA. UV-Index for the public: a guide for publication and interpretation of solar UV Index forecasts for the public prepared by the Working Group 4 of the COST-713 Action "UVB Forecasting". COST-713 Action. Brussels; 1999.
  4. United States Environmantal Protection Agency. Community-based ultraviolet radiation (UV) risk education: the SunWise Program handbook [Internet]. Cincinnati: U.S. EPA; 2002 [cited 2014 Aug 10]. Available from: http://nepis.epa.gov/Adobe/PDF/30004IQV.pdf.
  5. Zaninović K, editor. Climate atlas of Croatia 1961-1990, 1971-2000. Zagreb: Meteorological and Hydrological Service of Croatia; 2008.
  6. Chaillol I, Boniol M, Middleton R, Doré JF,Autier P, GavinA. Seasonality of cutaneous melanoma diagnosis in Northern Ireland with a review. Melanoma Res. 2011 Apr;21(2):144-51. Go to original source... Go to PubMed...
  7. Stanton WR, Janda M, Baade PD, Anderson P. Primary prevention of skin cancer: a review of sun protection in Australia and internationally. Health Promot Int. 2004 Sep;19(3):369-78. Go to original source... Go to PubMed...
  8. Walker D. Cloud effects on erythemal UV radiation in a complex topography. Veröffentlichungen/MeteoSchweiz. 2010;(86):1-106.
  9. Strnad M, Lipozenčić J. Epidemiology of skin tumours in world and Croatia. In: Lipozenčić J, Pašić A, Strnad M, Puizina-Ivić N, Ručević I, Barišić-Druško V, et al. Dermatologic oncology. Zagreb: Medicinska naklada; 2009. (In Croatian.)
  10. Celić D, Lipozenčić J, Jurakić Tončić R, Ledić-Drvar D, Marasović D, Puizina-Ivić N, et al. The incidence of basal cell carcinoma in Croatia: an epidemiological study. Acta Dermatovenerol Croat. 2009;17(2):108-12. Go to PubMed...
  11. American Cancer Society. Cancer facts & figures 2014.Atlanta:American Cancer Society; 2014.
  12. Marasović D. Incidence of skin tumours in different geographical areas [dissertation]. Split: University of Split, School of Medicine; 1996. (In Croatian.)
  13. Gandini S, Sera F, Cattaruzza MS, Pasquini P, Picconi O, Boyle P, et al. Meta-analysis of risk factors for cutaneous melanoma: II. Sun exposure. Eur J Cancer. 2005 Jan;41(1):45-60. Go to original source... Go to PubMed...
  14. Braun MM, Tucker MA, Devesa SS, Hoover RN. Seasonal variation in frequency of diagnosis of cutaneous malignant melanoma. Melanoma Res. 1994 Aug;4(4):235-41. Go to original source...
  15. Sun EC, Fears TR, Goedert JJ. Epidemiology of squamous cell conjunctival cancer. Cancer Epidemiol Biomarkers Prev. 1997 Feb;6(2):73-7.
  16. Republic of Croatia. Croatian Bureau of Statistics. Census 2001. Census of population, households and dwellings, 31st March 2001 [Internet]. Zagreb: CBS; 2001 [cited 2015 Dec 31]. Available from: http://www.dzs.hr/default_e.htm.
  17. Republic of Croatia. Croatian Bureau of Statistics. Census of population, households and dwellings 2011 [Internet]. Zagreb: CBS; 2011 [cited 2015 Dec 31]. Available from: http://www.dzs.hr/default_e.htm.
  18. Moehrle M, Heinrich L, Schmid A, Garbe C. Extreme UV exposure of professional cyclists. Dermatology. 2000;201(1):44-5. Go to original source... Go to PubMed...
  19. Schwartzbaum J, Ahlbom A, Feychting M. Cohort study of cancer risk among male and female shift workers. Scand J Work Environ Health. 2007 Oct;33(5):336-43. Go to original source...
  20. World Health Organization; InternationalAgency for Research of Cancer. Cancer incidence in five continents. Volume X. Lyon: IARC; 2014.
  21. Rogers HW, Weinstock MA, Harris AR, Hinckley MR, Feldman SR, Fleischer AB, et al. Incidence estimate of nonmelanoma skin cancer in the United States, 2006. Arch Dermatol. 2010 Mar;146(3):283-7. Go to original source... Go to PubMed...
  22. Van der Pols JC. Epidemiology of basal cell and squamous cell carcinoma of rhe skin. In: Dummer R, Pittelkow MR, Iwatsuki K, Green A, Elwan NM, editors. Skin cancer - a world-wide perspective. Heidelberg: Springer; 2011. Go to original source...
  23. Minelli L. Statistical survey of basal cell carcinoma in Londrina (Paraná, Brazil). An Bras Dermatol. 1987;62:321-5. (In Portuguese.)
  24. Lear JT, Harvey I, de Berker D, Strange RC, Fryer AA. Basal cell carcinoma. J R Soc Med. 1998 Nov;91(11):585-8. Go to original source... Go to PubMed...
  25. Freire-Maia N, Cavalli IJ. Albinism, skin carcinoma and chromosome aberrations. Clin Genet. 1980 Jan;17(1):46-7. Go to original source... Go to PubMed...
  26. Gasparro FP. The role of PUVA in the treatment of psoriasis. Photobiology issues related to skin cancer incidence. Am J Clin Dermatol. 2000 Nov-Dec;1(6):337-48. Go to original source...