Dr. Robert Kurrle, M.D., Senior AME
Ultraviolet Rays are the Demon
Summer is here and our exposure to the sun increases greatly along with the risk of skin cancer. Skin cancer is the most common form of cancer in the United States. The American Cancer Society estimates that during 2003, 1.3 million new cases of skin cancer will be diagnosed. This number is increasing each year. Skin cancer is divided into two major categories: non-melanoma (basal cell and squamous cell) and melanoma. The FAA views each category differently.
Our skin serves to protect our body from injury and infection, as well as help regulate body temperature. It is the largest organ, with a surface area greater than two square yards, and weighs about 11 pounds. The skin is divided into two layers - the surface epidermis and underlying dermis.
Ultraviolet (UV) radiation is the most important cause of skin cancer. The most harmful portion is the UVB rays, responsible for tanning as well as sunburn and skin cancer. Skin damage and cancer are caused by damage to the DNA in the skin cells. The damage is cumulative over our lifetime and often does not become apparent until years later. The repeated sunburns we had as children and adolescents may come back to haunt us in our adult life.
Basal cell carcinoma occurs on areas of skin exposed to sun, is the most common form, and comprises 75% of all skin cancers. It often appears as a small, fleshy, translucent bump on the face, ears, neck, or hands and has a smooth, waxy appearance. It is caused by overexposure to UV rays. It usually does not spread. It is easily treated with excisional biopsy or cryotherapy.
Squamous cell carcinoma also occurs on areas exposed to the sun and comprises about 20% of all skin cancers. It appears as a red bump and may feel scaly or nodular, on the nose, forehead and hands. It also comes from overexposure to UV rays. It has the potential to spread to other parts of the body. Most can be cured if detected early and completely excised. Actinic keratosis is considered precancerous and has a crusted, white scale over a raised red base and are 1-3mm in size. They are also caused by long term exposure to UV rays and may progress to squamous cell carcinoma. They are often frozen off with liquid nitrogen.
Malignant melanoma is less common, but is the most dangerous form of skin cancer and can be fatal if not treated. It can be found anywhere on the body, but most commonly on the upper back, arms and legs. It accounts for 5% of all skin cancers but 80% of all skin cancer deaths. Melanoma originates in the pigment cells of the skin called melanocytes and therefore is usually pigmented with a brown, black, or bluish color. It is variable in appearance, but often is asymmetric, with irregular borders, variable color, and diameter greater than 6mm. Melanoma also tends to have a raised surface. Melanoma is often caused by a history of severe, blistering sunburn as a child. Risk factors can also be a positive family history and abnormal moles. Melanoma is much more likely to spread to adjacent skin structures, have satellite lesions, and metastasize to the brain and other organs. A biopsy will confirm the diagnosis and treatment will be surgical removal with wide margins and possible lymph node biopsy to rule out metastases. If melanoma has spread to distal organs, usually the liver, lung, or brain, the five year survival drops to 5%.
The FAA views the non-melanoma and melanoma skin cancers differently. Pilots with basal cell or squamous cell carcinoma may return to flight duties after the cancer is completely excised. Reporting to the FAA can be done at the next medical renewal. It would be helpful to bring a letter from your treating physician describing the lesion, treatment, and recovery along with the pathology report. The FAA considers melanoma disqualifying for flying. The length of disqualification depends on the depth and stage of the melanoma. If the melanoma was superficial with no metastasizes, the pilot maybe able to return to flying as soon as treatment is complete. A physician letter, operative reports and pathology reports will be required. Metastases to distant organs are disqualifying for a minimum of 3 years following completion of treatment, while brain metastases are disqualifying for 5 years. This is to ensure no recurrence occurs. A special issuance will then be issued to the pilot.
The key to prevention is avoidance or protection from UV rays. The most intense sun is from 10am until 4pm. Long sleeves, sunglasses, and a wide brim hat are the best protection along with a good sunscreen with an SPF rating of 15-30 applied to all exposed areas 20 minutes before exposure and reapplied during the day. Remember, the effects of UV exposure are cumulative over our lifetime. The damage may not show up until years later. So, protect your children from intense exposure now to prevent them from having skin cancer as adults. As an adult, have your skin checked yearly by your family doctor or a dermatologist. It is easy to treat skin cancer when detected early, but can be devastating if left untreated.