Clear Skies, Hidden Dangers | Why pilots & aviation workers are at high-risk of skin cancer...& what you MUST do about it

As pilots, employers or workers in aviation, we're no strangers to assessing & mitigating risks. However, there's one often overlooked hazard we face, especially as we head into winter - skin cancer. In fact, pilots & airside workers are at high-risk of developing skin cancer compared to the average Australian - & with Australia having the highest skin cancer rates in the world, it's a serious work-place hazard. About two in three Australians will be diagnosed with skin cancer by the age of 70 & there are over a million treatments annually. The good news? Skin cancer is largely preventable - IF we take simple countermeasures.

Q: What is Skin Cancer?

Skin cancer is caused by DNA damage from solar UV radiation, leading to abnormal cell growth in the skin's outer layer. There are three main types:

1. Basal Cell Carcinoma (BCC), the most common, usually appearing as a pearly bump, are slow-growing and rarely spread (metastasize) but can cause extensive local tissue damage if left untreated.

   
   

2. Squamous Cell Carcinoma (SCC), a red nodule or scaly lesion also linked to UV exposure that typically invades locally but can also spread (metastasize)

   
   

3. Melanoma, the least common but most serious type, which can develop as a new mole or a change in an existing one, with a higher risk of spreading (metastasizing) to other parts of the body.

Did you know? 

• Pilots & air-side aviation personnel have TWICE the risk of melanoma

• Reflective surfaces (like aircraft & tarmac) increase UV exposure by up to 25%

• Airside aviation personnel get 5 to 10 times more yearly UV-exposure

Q: Which pilots & aviation workers are at the highest risk of skin cancer?

As pilots & aviation workers we already have twice the risk of skin cancer - however some have an even higher risk. If you have: fair-skin, freckles, light eye-colour, fair or red hair, many moles, burn-easily, a family or past history of melanoma or have a depressed immune system - you are at an even higher risk of skin cancer.

Q: Why is Skin Cancer Relevant to Pilots and Aviation Safety?

Our work in aviation as pilots, air-crew or ground-crew, exposes us to high levels of solar UV-radiation, increasing our risk of developing skin cancers, which can potentially impair or incapacitate due to spread (to the brain & other organs) or treatment side-effects.

Aviation increases the risk: on the ground pilots & workers airside are exposed to higher doses of cancer-causing UV-radiation from the sun & reflective surfaces (like the tarmac or aircraft). While, at cruising altitudes the thinner atmosphere exposes pilots to high UV-levels, incompletely blocked by the windshield. Whatever the cause, studies have demonstrated that pilots and air-crew have twice the risk of melanoma compared to the general population.

“At a cruising level of 30,000 ft, the UV level is twice that on the ground - and even higher when flying over thick cloud or snow fields, which can reflect up to 85% of UV radiation”.

Impairment & incapacitation risk: serious forms of skin cancer - especially melanoma - can impact aviation safety, because it can spread (to the brain or other organs) causing incapacitating pain, fatigue or seizures. While treatment side-effects from surgery, chemo, radio or immunotherapy can cause fatigue, nausea, vomiting & other aero-medically significant side-effects. For all these reasons, UV-exposure & melanoma are threats to our CASA medical certification & fitness-to-fly.

Q: What are the Symptoms and How is it Diagnosed?

Early detection of skin cancer is key, because treatment outcomes & survival are associated with the area & depth of invasion - for example: deeper & thicker melanomas are more likely to spread and be more resistant to treatment. Most melanomas are spotted by patients or their partners, so it's crucial to regularly scan your skin (even areas not usually exposed to the sun) in between regular clinical skin-checks and consult a specialist skin-cancer doctor if you notice any changes.

Just as we scan the skies for traffic, we must scan our skin for changes - such as: new moles, changes in existing moles (size, shape, or colour), non-healing sores, or persistent itching or tenderness. The "ABCDE" system can help spot potential melanomas & skin cancers: Asymmetry, Border irregularity, Colour variation, Diameter larger than 6mm, and Evolving changes. Diagnosis is best made by a specialist skin cancer doctor trained in the use of dermoscopy with a biopsy for definitive diagnosis.

Q: Can I Fly with Skin Cancer & How Will it Affect my Medical Certificate?

In general, Yes - but it depends on the: diagnosis, type of cancer, its stage and how it’s treated. It’s important to remember that CASA assesses each pilot’s situation on a case-by-case basis.

1. Basal Cell Carcinoma (BCC) and Squamous Cell Carcinoma (SCC): are generally less aggressive and if early-stage, fully treated, or completely excised, pilots can generally continue to fly without restrictions. However, if there are complications such as local invasion, metastatic spread (less common) or aggressive features on histopathology, further evaluation will be required.

   
   

2. For Melanoma: the depth of spread - measured by the Breslow thickness - is critical. For low-risk melanoma with a Breslow Level of < 0.75 mm & no evidence of metastatic spread generally should not impact medical certification - but CASA will likely require histopathology reports from biopsies, annual dermatology surveillance & reports for up to 5 years.

   
   

3. Treatment, Prognosis & Risk of Recurrence: Certain treatments (like chemo, radio or immunotherapy), an unclear prognosis or pilots with a high-risk of recurrence may require temporary grounding, more frequent medical evaluations or multi-crew restrictions - to ensure that they meet the required standard for medical certification & aviation safety.

Q: How is it Treated?

Treatment for skin cancer depends on the type and stage. For most skin cancers, topical treatments, cryotherapy or surgical excision is curative. Mohs surgery for more serious skin cancers, is more precise with high cure rates, often used for Basal Cell Carcinoma (BCC) and Squamous Cell Carcinoma (SCC) to remove cancer cells while saving healthy tissue. Radiation therapy may be used if surgery isn’t an option, and for advanced melanomas or cases where the cancer has spread, chemotherapy or immunotherapy might be recommended.

Q: What countermeasures can pilots, employers & aviation workers take?

Aviation-related UV-exposure & skin cancer are threats to our health & medical certification - so it’s important for pilots, employers & aviation workers to take countermeasures to prevent & detect skin cancer.

Prevention: minimising sun exposure is key to minimising skin cancer risk - you should Slip on a shirt, Slop on 50+ sunscreen, Slap on a wide-brimmed hat, Seek shade & Slide on your aviators. Finally, pilots & aviation workers may consider taking oral Vitamin B3 (in consultation with your GP) - as studies have shown that 500 mg twice daily significantly reduces the risk of non-melanoma skin cancers (SCC & BCC).

Early Detection & Regular Skin-checks: because pilots & aviation workers have twice the risk of melanoma you should book a yearly to six-monthly skin-check (depending on individual risk) with a specialist skin cancer doctor as part of your preventative maintenance cycle. In between these scheduled checks, regular self-examination is key using the ABCDE system: Asymmetry, Border irregularity, Colour variation, Diameter larger than 6mm, and Evolving changes. If you are concerned or notice any of these changes book an appointment with a specialist skin cancer doctor.

The Debrief - Take home messages

1. Pilots & airside aviation workers have twice the risk of skin cancer - due to high exposure levels on the ground and in the air

   
   

2. Aviation employers are obligated to mitigate the risk - under WHS laws employers must educate & provide their pilots, cabin crew, ground-crew & maintenance engineers with protection or surveillance countermeasures.

   
   

3. UV-exposure & Skin cancer are threats to your health & medical certification - due to the potential impact on pilot performance and aviation safety

   
   

4. There are three main types of skin cancer - Basal Cell Carcinoma (BCC), Squamous Cell Carcinoma (SCC), and Melanoma - all are linked to UV exposure.

   
   

5. Prevention & early detection with annual skin checks are key - slip, slop, slap, seek, slide + six-monthly to yearly skin checks & self-examination using ABCDE system are essential

Q: Got more questions?

Contact us: info@aerokare.com.au

References & links to more information:

1. https://www.casa.gov.au/licences-and-certificates/medical-professionals/dames-clinical-practice-guidelines/melanoma

2. https://www.dermcoll.edu.au/atoz/skin-cancer-overview/

3. https://www.skincancer.org/skin-cancer-information/basal-cell-carcinoma/

4. https://www.skincancer.org/skin-cancer-information/squamous-cell-carcinoma/

5. https://www.skincancer.org/skin-cancer-information/melanoma/

6. https://www.skincancer.org/skin-cancer-prevention/sun-protection/

7. https://www.cancer.org.au/about-us/policy-and-advocacy/prevention/uv-radiation/related-resources/early-detection

8. https://pmc.ncbi.nlm.nih.gov/articles/PMC4482339/#:~:text=Pilots%20and%20cabin%20crew%20have,optimal%20occupational%20protection%20is%20needed.

9. https://www.nejm.org/doi/full/10.1056/NEJMoa1506197#t=article