Male firefighters may have an increased risk for melanoma compared with nonfirefighters, according to findings from a study published in the Journal of the American Academy of Dermatology.
Researchers conducted a systematic review of occupational case-control studies on PubMed from inception through May 13, 2022, involving melanoma risk in career firefighters. Eligible studies were English-language articles that reported melanoma incidence in career firefighters in a case-control study design or with an analytic method. Studies including volunteer firefighters (part-time, without benefits) and those regarding the World Trade Center in New York City on September 11, 2001, were excluded.
Investigators followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data were obtained for the cases, control individuals, odds ratios (ORs), and standardized morbidity ORs (SMORs). The Newcastle-Ottawa Scale was adapted to assess study quality.
A total of 5 articles were included in the analysis. All of the included studies used state tumor registry data, and occupation was based on registry responses or fire marshal’s office certifications.
An increased melanoma risk among male firefighters compared with nonfirefighters was reported in 80% of studies. In 2 of the studies, police officers were used as a control group. Neither of these 2 studies found a significantly increased melanoma risk in firefighters compared with police, although 1 article found an increased risk in firefighters compared with police officers 55 to 74 years of age (SMOR 5.13; 95% CI, 1.5-17.5) and firefighters compared with all occupations (SMOR 2.92; 95% CI, 1.7-5.03). In another study, a lower risk was observed in firefighters compared with police officers (SMOR 0.65; 95% CI, 0.44-0.97) as well as an increased risk compared with individuals 18 to 54 years of age in all occupations (SMOR 1.82; 95% CI, 1.09-3.04).
Study limitations include the inability to separate occupational exposures from well-known melanoma risk factors, and melanoma risk may vary in geographic areas not represented in the review. In addition, outcomes were dependent on registry data quality, and firefighters may have had other occupations that affected their cumulative exposure. Furthermore, researchers acknowledged, the study focused on career firefighters representing one-third of US firefighters, and 4 studies excluded female firefighters.
Investigators noted that future studies could include data on carcinogenic and ultraviolet exposures, sun-protection behavior, and personal and familial skin cancer history for risk evaluations.
“Firefighters may benefit from targeted screening initiatives to detect skin cancer since they may be unaware of their risk,” concluded the study authors.
Valek SA, Rousseau MA, Nelson KC, Kannler C, Tran T. Melanoma risk among career firefighters: a systematic review of case-control studies. J Am Acad Dermatol. Published online December 30, 2022. doi:10.1016/j.jaad.2022.11.058