Flying free of skin cancer

Brought to You by - Brent Taylor, MD, Premiere Dermatology and

Mohs Surgery of Atlanta

In the last month, two airline pilots have come to see me for suspicious spots that proved to be invasive malignant melanomas. As an instrument-rated recreational pilot myself, I sympathize and understand that the stakes involved for commercial pilots are not only health and lifespan but also work and livelihood. Pilots are sometimes wary of physicians, but it is critically important for pilots and non-pilots alike to know that early diagnosis is the best way to keep your wings and your life.

The FAA is very strict with pilots’ health. Regular health examinations with an FAA flight examiner are required of all pilots. For pilots over the age of 40 acting as “pilot in command” of a commercial airline flight, a medical certificate must be renewed every 6 months by means of a thorough flight physical. The running joke among physicians who take care of pilots is that non-pilots come in with a list of ten maladies and complaints whereas pilots respond to every question about possible illnesses with single word answers ranging from “nope” to “never.” Most jokes have a grain of truth. Pilots do not want an illness on their medical record that might result in an inability to fly.

Sometimes, you can make a case for someone trying to fix an illness without a physician’s help. For example, someone at the edge of type II diabetes might restore his or her own health with disciplined diet and exercise and be healthy by the time medical certificate renewal comes around.

Not so with melanoma. Don’t delay. Don’t try to fix it yourself. If a spot is changing, get that spot checked out! Melanoma continues to grow as long as it is left in place. The single most important feature of a melanoma is how deep it has grown. A melanoma that is less than 0.80mm is generally considered “good” with a low risk of having spread to other parts of the body.

The FAA draws the line in the sand for melanomas at 0.75mm. Melanomas less than 0.75mm deep need only documentation of no clinical signs of metastatic disease and complete removal with clear and appropriate margins. Then, the flight examiner can issue the medical certificate to allow a pilot to keep on flying. This means that a simple excision by a dermatologist under local anesthesia for a shallow melanoma in almost all cases allows a pilot to keep his or her ability to fly. Melanomas deeper than 0.80 mm often require lymph node biopsies under general anesthesia, imaging such as MRI and/or PET/ CT scans. Even then, permission to fly is not guaranteed. Instead, all documents must be submitted to the FAA for consideration of permission to continue flying which is called “Special Issuance Authorization.” It wouldn’t be called “Special” if it were routine and for everyone.

Both pilots who came to me recently with melanomas had noticed the spot changing for a few months, and both cases had measured depths of 0.7mm. Talk about cutting it close! Just a little more growth and those pilots might have lost their medical certificate. Just as importantly, a little more growth would have pushed them into a higher risk category with a much higher chance that the melanomas could have spread.

In my practice, I have so far always been able to honor the policy that a patient who is worried about a single spot that is changing and could be a melanoma can be added onto my schedule within a day for a “spot check” even if my schedule is fully booked. We might not have time to complete a full body skin exam at an overbooked appointment, but I never want scheduling problems to be the reason that a melanoma diagnosis is delayed. Likewise, I typically work from 7am to 5pm but add on melanoma excisions at 6:30am or 5pm to make sure patients are treated as quickly as possible.

For so many reasons, people are afraid to go to the doctor, but in the case of dermatology, it is in one’s interest to seek care. Getting that suspicious or changing spot checked out should be a priority. Even if your job isn’t on the line, early detection of skin cancer can save your life.