Protect yourself in the air and on the ground.
With the highest rates of skin cancer in the world, Australians are most at risk of developing melanoma and non-melanoma lesions. Every year, a million non-melanoma skin cancers are treated across the country.
For airline workers, these skin cancers are a larger threat. Non-melanoma skin cancer is the most common type of cancer among pilots and flight crew, accounting for up to 60% of all cancers in this population.
However, as the travel bug spreads across the country, ways to mitigate the skin cancer risk while flying are useful for all Australians to know.
What is non-melanoma skin cancer?
Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) are collectively commonly referred to as non-melanoma skin cancers. They are the most common skin cancers — comprising 90% of diagnoses in Australia — but, fortunately, are also less aggressive than melanoma and rarely spread throughout the skin.
Risk factors for non-melanoma skin cancer
Excessive sun exposure is the primary cause of developing basal cell carcinoma and squamous cell carcinoma. People who live or work at high altitude levels or in year-long sunny areas, like flight crews, have a higher risk of SCC and BCC.
Other factors that contribute to one's risk of non-melanoma skin cancer include:
- a personal or family history of skin cancer
- a large number of moles
- fair skin type or skin colour — however, sites of pre-existing inflammatory conditions or burns on dark-skinned people are common areas for SCC to develop
- a history of sunburn
- a compromised immune system or are on immunosuppression medication
- indoor tanning
- age — most basal cell and squamous cell carcinomas develop after 50.
Signs and symptoms of non-melanoma skin cancer
Unlike the dark brown or black spots of melanoma, basal cell carcinoma and squamous cell carcinoma grow out of skin-coloured lumps which will become crusty and bleed. Squamous cell carcinoma may be tender to the touch, whereas basal cell carcinoma tends to appear more red in colour.
- Asymmetry: if both halves do not look the same.
- Border: changes in a mole's borders, such as spreading or scalloped or irregular edges.
- Colour: blotchy spots in the colour of the mole, the presence of many colours or a recent change in its colour.
- Diameter: if it is larger than 6mm (about the size of a pencil eraser).
- Evolving: differences or growth in a mole's size, shape or thickness.
Diagnosing and treating non-melanoma skin cancer
Basal cell carcinoma is the most common type of non-melanoma skin cancer among aircrew, accounting for up to 80% of cases. If left untreated, BCCs can grow deeper into the skin, invading nerves and potentially damaging nearby tissue. These side effects complicate treatment. Moreover, having one BCC increases the risk of getting another (Hugh Jackman, for example, has been diagnosed with basal cell carcinoma six times). Multiple basal cell carcinomas can appear in multiple places on the body simultaneously.
Up to 20% of cases of non-melanoma skin cancer among airline pilots and cabin crew are squamous cell carcinoma. SCC grows much quicker than BCC, and develops in the outermost layer of the skin. If left untreated, squamous cell carcinoma is more likely to spread, particularly if it initially develops on the lips and ears.
For this type of non-melanoma skin cancer, excisional surgery is the most common form of treatment. However, for early lesions, cryotherapy with liquid nitrogen or even topical creams could also be considered. Alternatively, for basal cell carcinoma, common treatment methods include excisional surgery, cryosurgery (freezing the lesion with liquid nitrogen), topical chemotherapy creams, or photodynamic therapy. However, if either non-melanoma skin cancers reach the lymph nodes, radiation therapy or drug therapies, such as immunotherapy, targeted therapy or chemotherapy, may be necessary.
The importance of sun protection for pilots and flight crew
A 2018 meta-analysis study revealed that pilots and airline crew are occupationally exposed to more UV and cosmic radiation than the general population. This is because the Earth's atmosphere is less filtered and thus provides less protection at typical cruising altitudes of commercial aircraft (7000 to 12,000 metres) than at ground level. Hence, the same intense risk of non-melanoma skin cancer that the average Australian is at risk of is increased for airline cabin crew and pilots.
The effects of radiation on pilots and flight crew
The risk of non-melanoma skin cancer increases with the number of hours flown, with pilots and flight crew who fly more than 1000 hours per year having a 2.3-fold higher risk than those who fly fewer than 1000 hours.
According to an article by CBS News, there is a greater risk for flight attendants and pilots on planes with glass windows rather than plastic. While the sheeting on aeroplane windows blocks most UV radiation, glass lets in more UVA rays (a type of ultraviolet light) than plastic. UVA radiation contributes to a greater risk of melanoma. In fact, one study found that a pilot flying in the cockpit for under an hour at 30,000 feet is exposed to the same amount of UVA radiation as a 20-minute tanning bed session.
However, the lamination on plane windows offers greater protection against UVB rays, the ultraviolet radiation that increases the risk of BCC and SCC. Nonetheless, there are greater calls among the scientific community for more measurements by the Federal Aviation Administration in the United States, and globally, to mitigate UV exposure for airline crew.
Preventative measures for pilots and flight crew — clothing
Since chronic overexposure to sunlight is the leading cause of non-melanoma skin cancers, sun avoidance is the most effective prevention method for airline cabin crew, especially during the peak sunlight hours from 10 am to 3 pm.
But, considering the characteristics of this industry and the altitudes flown at, sun prevention consists of wearing protective clothing and sunscreen when flying. Similarly, pilots and flight crew should also wear UV-blocking sunglasses to protect their eyes from the sun’s ultraviolet rays. Using and frequently reapplying a broad-spectrum sunscreen rated SPF30+ on all exposed skin, even on cloudy days, is vital as well.
The importance of regular skin checks for pilots and flight crew
Early detection is key to protecting yourself from skin cancer. Regardless of your occupation, it is recommended that Australians have an annual skin check for suspicious moles and lumps. Airline crew, due to their intense risk of UV radiation exposure, should have their skin checked more regularly.
Looking after your skin, in the air and on the ground
Skin cancer is, unfortunately, Australia's cancer. But when you're up in the sky, you're at risk of less filtered UV rays, for the appreciated job of transporting Australians across the world. Maintaining preventative, sun-smart habits is important to protect your health.