For Your Pilot: Get Informed about Melanoma!

A week after a checkup at my dermatologist, the phone rang.

“We have the results of your biopsy,” the physician’s assistant on the other end said. “It’s melanoma.”

For more than five years, I had had a dark spot beneath my right eye. It had become something of a joke since its coloring and location resembled a gangster’s teardrop tattoo. Now I was being told that the mark on my face was a malignant skin cancer.

I had started going for annual dermatology exams several years earlier when I first noticed the spot. About the same time, I had become aware that flight crews have an elevated risk for certain types of cancer.

Several studies over the past few decades have found a strong link between flight crews and melanoma. Aviation is linked with other types of skin cancer and breast cancer as well. JAMA Dermatology reported in 2015, “Flight-based workers are thought to have a greater occupational hazard risk of melanoma owing to increased altitude-related exposure to UV [ultraviolet] and cosmic radiation.”

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Some risk factors for pilots are the same as for other melanoma patients. Exposure to ultraviolet radiation, most commonly from sunlight or tanning beds, is a major risk factor, according to the American Cancer Society. The presence of a large number of moles also increases the possibility of melanoma. Fair skin, childhood sunburns, and family history of melanoma are also common to many melanoma patients.

All skin types are susceptible to skin cancers. While pilots with fair skin are at higher risk, cancers can be harder to detect on darker skin shades.

For flight crews, time at high altitudes was another strong predictor of skin cancer. The study found that a one-hour flight at 30,000 feet exposed a pilot to about as much UV-A radiation as 20 minutes in a tanning bed. The study notes that airplane windshields do not provide full protection from UV-A rays. Melanomas were prevalent in pilots who flew primarily in the low latitudes. Pilots who flew in high latitudes, where UV rays are not as strong, had non-melanoma skin cancers.

Not coincidentally, my melanoma was on the right side of my face, just below the area covered by my sunglasses. As a pilot who entered the industry just after September 11 and just before the wave of airline bankruptcies that followed, I spent 10 years as a first officer sitting in the right seat with the right side of my face inches away from the window.

When I received my diagnosis, my doctor recommended removing the melanoma as soon as possible. Melanoma is not the most common form of skin cancer, but it is one of the most deadly. The key is early detection and removal.

The following week, the doctor removed the melanoma in an outpatient procedure that took about an hour. He used the Mohs technique in which local anesthesia was used and one layer after another was stripped away until the entire growth was gone. It was relatively painless. Following confirmation that the cancer was removed, he closed the wound with stitches.  

Both before and after my experience, I have heard from many other pilots with similar stories. If you spend a lot of time at high altitudes, as most professional pilots do, it is recommended that you get regular dermatology screenings and know the signs of skin cancer.

When it comes to skin markings, remember “ABCDE”:

A-Asymmetry – Moles are typically symmetrical. If you draw a line through the middle, each side will match. The two halves of cancers will usually not match.

B-Border – Moles have smooth borders. Cancers have uneven edges that can be scalloped or notched.

C-Color – Moles are usually a single color. Cancers contain different shades.

D-Diameter – Moles are small. Melanomas are often larger than a pencil eraser (1/4 inch or 6 mm).

E-Evolves – Moles don’t change. If a mole grows, becomes elevated, changes color or new symptoms such as bleeding or itching develop, see a doctor.

Skin Cancer Prevention

It is also easy to take preventive action to minimize your risk of skin cancer. One of the most important steps that you can take is to wear sunscreen (SPF 15 or higher). Make putting it on a part of your daily routine anytime you’ll be in the sun, especially when you will be flying at high altitudes. If your uniform standards allow long-sleeve shirts, wear them; this is another way to protect your arms. Larger noise-canceling headsets like the popular Bose models used in many jets protect more of your head from UV rays than small headsets that don’t completely cover your ears. When not flying, wear a broad-brimmed hat when you're out in the sun.

As for sunglasses, make sure that they block UV rays. Polarized sunglasses don’t mix well with glass cockpits so I have one pair of shades for flying and another for everything else. I keep my nonpolarized Ray-Bans for cockpit use and have polarized glasses for driving and other outdoor activities.

Even if you fly only at night, you still are at risk. Not all cosmic radiation is visible. Freight pilots and others who fly the back side of the clock may still be exposed to solar radiation in spectrums outside that of visible light.

If you do get skin cancer, it isn’t necessarily the end of your career, particularly if you catch it early. After a cancer is removed, the FAA guidelines may allow an AME to reissue the medical certificate depending on the type and size of the cancer and whether it has metastasized to other parts of the body. In the case of melanoma, if the cancer is in situ or less than 0.75 mm deep with no recurrence or metastasis, the AME can issue the certificate. In other cases, he or she may have to submit documentation to the FAA for approval.

While protecting your flying career is important, protecting your life is vital. Becoming aware of the risks of melanoma and other skin cancers for professional pilots is an important part of prevention, early detection, and treatment. Make an appointment to see a dermatologist and pick up a bottle of sunscreen to keep in your flight kit. It may save your life.