The occupational disease "Squamous Cell Carcinoma or Multiple Actinic Keratoses of Skin Due to Natural UV-Exposition" (BK # 5103) has been established in Germany in 2015. We report on real life assessment at a Municipal Hospital. A total of 60 consecutive insured employees have been included. The median age was 71.0 ± 8.2 years. Only a single employee was female. The following professions were involved: Masons (10), teachers/educators (6), electricians/high-voltage electricians (5), roofers/roof plumbers (5), car mechanics/drivers (5), farmers/gardeners (4), road builders (3), plumbers (3), engineers/technologists (3), locksmiths/mechanics/machine builders (3), and others. Among the reviewed employees 91.7 % (55) presented with AK and 71.7 % suffered from SCC. The anatomical distribution of AK was head (96.7 %), back of hand (53.3 %), lower arm (21.7 %), back (10.0 %), upper arm (6.7 %), lower leg and lower lips (5.0 % each). SCC presented the following distribution (43 employees): scalp (93.0 %), cheeks and ears (37.2 % each), temple and forehead (16.3 % each), lower lips and lower arm (11.6 % each), shoulders (9.3 %), nose, upper arm, back of hand, and breast (7.0 % each), neck and back (4.7 % each), chin and lower leg (2.3 % each). One patient had a history of 45 (!) SCC, which could not be classified according to the anatomical region because of missing details. He was not considered for anatomical distribution and classification. Cutis rhomboidalis nuchae had been classified according to severity: Grade 0 - 10 x; grade 1 - 20 x; grade II - 16 x, and grade 3 - 15 x. It seems remarkable that despite significant UV-exposure of the dorsal neck only a single carcinoma in situ (Tis) has been observed. This employee had a cutis rhomboidalis-grade of zero. SCC have been classified as follows: Tis (n = 40), T1 G0 (2), T1 G1 (17), T1 G2 (41), T1 G3 (1), T2 G2 (3), T2 G3 (3), T2 G4 (1), T3 G2 (1), T3 G3 (1). The dominating tumors were Tis and T1 G2 SCC. We had two cases of metastatic SCC - one with parotid involvement, one with subcutaneous and pulmonary metastases. The recognition rate of occupational disease BK 5103 attained 90 %. Rejection in 6 cases was justified by absence of multiple AK or field cancerization or SCC (n = 4) or by occupational UV-exposure of less that 40 % of life-time UV-exposure (n = 2). The reduction of employability (MdE) has been calculated 0 % or < 10 % in 33.3 % (18), 10 % in 31.5 % (17), 20 % in 27.8 % (15), 25 % in 1.9 % (1), and 40 % in 7.4 % (4). The highest MdE was justified in 3 of 4 cases by disease activity including metastases in two cases. In another case disease activity was missing but this employee suffered from facial verve palsy and facial disfigurement after tumor treatment. [ABSTRACT FROM AUTHOR]