Skin Cancer Remains Serious Concern for Flight Crews

Health Watch

By ALPA Staff

It’s widely known that pilots and flight attendants are exposed to elevated levels of ultraviolet (UV) and cosmic-ionizing radiation and that prolonged exposure increases the risk of developing different kinds of skin cancers. The National Institute for Occupational Safety and Health this past January reported, “We know the level of UV radiation is higher at commercial aircraft altitudes than it is at sea level, but we don’t know exactly how much UV radiation is blocked by the windshield and cabin windows on all commercial aircraft.”

To further complicate matters, the very nature of airline operations can be another contributing factor. The Centers for Disease Control and Prevention (CDC) has stated, “Some studies suggest that circadian rhythm disruption may also cause [skin] cancer.” The CDC acknowledged that this disruption includes irregular work schedules, jet lag, and crossing multiple time zones.

The incidence of skin cancer among flight crews has been found to be twice that of the general population, but the bulk of the research drawing this conclusion was collected several decades ago. However, a study concluded in 2018 by the Harvard T.H. Chan School of Public Health on the prevalence of skin cancer among flight attendants positively identified higher incidence rates. Yet despite this finding, researchers acknowledged that they couldn’t specifically determine the source of the increased risk.

Regardless of the source, skin cancer remains a serious concern for flight crews. The good news is that most cases are preventable and, when detected, often treatable.

The Skin Cancer Foundation describes skin cancer as “the out-of-control growth of abnormal cells in the epidermis, the outermost skin layer, caused by unrepaired DNA damage that triggers mutations.” Those at a higher risk typically include individuals with lighter skin color, blond or red hair, an abundance of freckles/moles, and a family history of the disease. Because of their exposure, the scalp, ears, neck, face, arms, and hands are the most common places to find these growths.

Melanoma and nonmelanoma are the two basic types of skin cancer. Melanoma is the more serious of the two and develops from melanocytes, the skin cells that produce melanin pigment that give skin its color. Malignant melanoma is the cancerous form of uncontrolled melanocyte growth that, without treatment, can metastasize to other parts of the body. Growth of melanocytes can also cause benign moles.

Nonmelanomas typically include basal cell carcinoma and squamous cell carcinoma, although there are some other less-common variants. These two examples are the result of cumulative sun exposure, as the risk of skin cancer increases with age.

In the United States, the FAA provides clear guidance to aviation medical examiners (AMEs) who assess pilots with skin cancer for medical certification purposes. “Decision Considerations–Aerospace Medical Dispositions, Item 40” explains how cases are to be handled.

In Canada, the evaluation of pilot skin cancer patients is on a case-by-case basis. Transport Canada and Civil Aviation Medicine allow AMEs some discretion in determining when pilots are fit to fly, but any malignant cases must be treated for a pilot to return to the flight deck. More serious melanomas may require an observation period after treatment before medical clearance is obtained.

As a general safety precaution, it’s recommended to

  • limit direct contact with the sun between the hours of 10:00 a.m. and 4:00 p.m.,
  • protect skin with appropriate clothing, hats, and sunglasses when outdoors during the daytime,
  • regularly apply sunscreen with an SPF 15 or higher when outdoors during daylight hours,
  • avoid tanning booths/sun lamps, and
  • read medication labels carefully for possible skin-sensitizing side effects.

If you notice a significant change to your skin, make an appointment to see a dermatologist who can examine the change to determine the cause.

More Questions?

U.S. ALPA members with questions about skin cancer are encouraged to contact the Aviation Medicine Advisory Service, ALPA’s Aeromedical Office. Call 303-341-4435, Monday through Friday, 8:30 a.m. to 4:00 p.m. mountain time, to speak with a physician about approved treatments and medical certification. Canadian members with questions can call Canadian Pilot Peer Support at 309-777-2572.

This article was originally published in the June 2021 issue of Air Line Pilot.

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