Occupational Pesticide Exposure and Risk of Non-melanoma Skin Cancer Among U.S. Adults: A Systematic Review.

Non-melanoma skin cancer (NMSC), including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), is the most common cancer diagnosed in the United States. Although ultraviolet (UV) radiation is the major risk factor, occupational exposure to pesticides has been proposed as an additional contributor among agricultural and other outdoor workers. This systematic review evaluated the available evidence on the association between occupational pesticide exposure and the risk of NMSC among U.S. adults. Following PRISMA 2020 guidelines, PubMed, the Excerpta Medica database (Embase), Web of Science, and the Cochrane Library were searched for eligible observational studies published between 2015 and March 2026. Study quality was assessed using the Newcastle-Ottawa Scale (NOS). The search yielded 490 records, and 26 studies met the inclusion criteria. Across the included studies, workers with prolonged pesticide exposure, frequent dermal contact, longer employment in agricultural settings, and inconsistent use of personal protective equipment generally had a higher risk of NMSC. Several studies also described biological mechanisms, including oxidative stress, chronic inflammation, and DNA damage, that may explain this relationship. However, differences in exposure assessment and the influence of concurrent ultraviolet exposure limited direct comparisons between studies. Current evidence supports an association between long-term occupational pesticide exposure and increased NMSC risk, but additional prospective studies using more accurate exposure measurements are needed to strengthen the evidence.