Flight Crews at Double Risk of Developing Skin Cancers

DALLAS — According to research published by the US NLM and ARPANSA, airline pilots and cabin staff had nearly twice the risk of Melanoma and other skin cancers as the general population, with pilots having a higher risk of dying from Melanoma.

As we kickstart Skin Cancer Awareness Month, Airways shares with our readers the personal story of Elise S. May, an aviation safety professional, and her husband, a pilot for a major US carrier, to raise awareness of this health issue among flight crews and aviation enthusiasts.

A Simple Skin Cancer

Most people think of Melanoma as simply skin cancer. A mole you have removed and never think about again. We were actually those people back in 2001. My husband had a mole removed from his chest that came back as Stage 1 Melanoma. In 2001, there was no additional treatment needed for Stage 1.

Since Tommy was a pilot, the FAA required him to get brain scans and chest x-rays for five years. After that point, he was considered cured, and we never gave that pesky mole much thought.  

Fast forward to late December 2019. For a few weeks, Tommy had been showing some cognitive challenges. I slowly started to notice I was finishing his sentences as he could not do so. He was having trouble following our conversations, and I found myself asking him to please focus on what I was saying. At first, this was not alarming. As we all know, pilots can be good at tuning others out when they want to.

However, it continued and moved past not just focusing. I could tell something was just not right. I encouraged (he would say nagged) my husband to seek medical attention. He refused because he was worried about the FAA pulling his medical. He told me, “I can’t go in saying I am having cognitive challenges. I will never fly again.”

My husband worked hard to become a pilot, putting himself through flight school, flying canceled checks, and taking any corporate job he could get to build hours. As an aviator with more than 30 years of experience, he was not going to give that up easily. 

The final straw came as we went to Home Depot on a Saturday afternoon, and Tommy could not park the truck. I burst into tears and begged him to go to the hospital. As a  two-time cancer survivor myself, my mind always went to the worst-case scenario so I  was terrified. As we walked through the hospital parking lot, Tommy silently grabbed my hand.

Nothing Would Be the Same

I knew at that moment, that our lives would never be the same. Walking into the hospital that day took every ounce of strength I had. That is until I had to walk out alone without my beloved husband just a short 10 months later. 

Once at the hospital, things moved quickly. In that small, cold, sterile ER room, the doctor said six little words. There is something on the scan. These six words were followed by the very young, very non-emotional doctor asking if we wanted to know what they saw. The old saying, “ignorance is bliss” could not have been further from the truth. I wanted to beg him to not say another word. However, Tommy, my very practical husband, wanted to know.

“There are three lesions on your brain,” said the doctor. My heart literally stopped at that moment. At this point, they started asking about medical history. I began rattling off kidney stones, cataracts, a recent sinus infection; nothing of significance. Tommy then said to not forget the mole from 19 years ago. Every head in the room turned at that comment, and we all knew the Melanoma was back, and with a  vengeance. 

I frantically called our trusted dermatologist, Dr. Jerald Sklar, who had become a friend as well over the past 20 years. He shared our dismay that the Melanoma was back, as he had constantly monitored Tommy over the years. My husband was diligent about getting regular skin checks, and while he often had spots removed, nothing was concerning. Throughout his 30 years as a dermatologist, Dr. Sklar has treated numerous pilots and places an emphasis on thorough skin checks.

According to Dr. Sklar, Melanoma is much more prevalent in pilots than my husband or I ever realized. A study in JAMA Dermatology, published by the American Medical  Association, highlighted that flight crews have twice the incidence of Melanoma compared with the general population.

The time spent at higher altitudes, travel to tropical destinations which are closer to both the equator and the sun, as well as interruptions to a crew member’s circadian rhythm have all been cited as putting an individual at high risk for all types of skin cancer. 

Preventing Skin Cancer

We have all heard about the importance of sunscreen to prevent skin cancer, and that is especially important for pilots. Our flight surgeon recommends any product containing  40 SPF or higher. It is equally important to have regular skin checks with a  dermatologist. On the skin, warning signs to look for are a new spot or one that begins changing in shape, color, or size.

It is also important to pay attention to spots that may look different from others on your body. This was the case with Tommy’s original mole.  It had started to look different, so he realized it was time to have it checked out.  

Melanoma can lay dormant for many years as was the case with my husband. It most frequently spreads to the brain and/or lungs (hence the reason the FAA required brain scans and chest x-rays). Unfortunately, the spreading of Melanoma to other organs cannot be recognized by a simple skin check. Once the signs begin showing, it often means the disease has progressed. Again, the reason prevention and early detection are so very important. 

According to MD Anderson, Melanoma only accounts for 3% of skin cancers but is more likely to metastasize to other parts of the body. Once it reaches the brain, the prognosis is not good at all. However, my husband was ready for battle. The stubborn,  perfectionist pilot in him was going to defy the odds.

Brain surgery was followed by targeted therapy, but there were roadblocks everywhere we turned. Each scan showed more progression of the disease, but we never thought of Tommy not beating it. He continually spoke of getting his medical back and finishing his last five years with American Airlines (AA). 

The Face of Melanoma

Sadly, my brave, strong, amazing husband lost his battle a short 10 months after being diagnosed. We were so convinced he would be okay that we never talked about what would happen if he didn’t make it. To say I am heartbroken is an understatement. 

Tommy and I were supposed to grow old together, and that won’t happen. He was supposed to be here to watch his daughter raise his grandson. He was supposed to be here as our son follows in his footsteps as a commercial pilot. Melanoma is not fair. Cancer is not fair.  

This is the face of Melanoma. My husband, AA pilot Thomas Christiansen. For those of you reading this, wear your sunscreen every single day, especially when you are flying. Please have regular checkups with a dermatologist. 

Please seek medical attention when needed, and don’t put it off because you are worried about your FAA medical. Your loved ones don’t care about that medical. They care about you and want you here with them.  

For more information about Melanoma, please visit AIM at Melanoma Foundation  (aimatmelanoma.org). 

For information about disability benefits for pilots, visit the Facebook group Pilots - Loss of License / Grounded / STD / LTD. These sites were both helpful to us as we navigated thru this difficult time.

Article written by Elise S. May. Featured image: Thomas Christiansen. Photo courtesy of Elise S. May

This story is for general information purposes only. Its contents are not intended to be a substitute for professional medical advice, diagnosis, image interpretation, or treatment. Airways recommends seeking the advice of your physician or another qualified health provider with any questions you may have regarding any medical condition.