All but the most minimally invasive skin cancers, such as basal or squamous cell, will require FAA review prior to issuance of any class of medical certificate. Your aviation medical examiner may issue a certificate if you have been successfully treated for squamous or basal cell carcinoma, provided the status report and pathology reports are favorable, showing clean excision, clear margins, and no evidence of metastasis.
Melanoma is reviewed on the basis of the location of the original tumor, the scoring, and extent of lymph node involvement. Continued certification will require reevaluation (usually every six months). The periodic follow-ups may be required for several years because of the recurrence rate for these types of tumors.
Lesions found to be 0.75mm or less on the Breslow scale may be reviewed more favorably than larger lesions. Approval is based, among other things, on the likelihood of sudden incapacitation, as in the case of tumor spreading to the nervous system and brain, resulting in a seizure or other incapacitating neurologic event. Evidence of metastasis, or spread of the cancer, and if so, how rapidly it is spreading, is also a major consideration. Additionally, the presence of any degree of disability related to the treatment is also important. All treatment must have been completed before any records are provided to the FAA.
Oncologists use the Breslow scale to determine the extent of melanoma involvement. Breslow scale and involvement of local lymph nodes are key factors in determining eligibility. If the melanoma is less than Breslow 0.75-mm depth, the FAA will require a yearly status report from the treating physician for at least 5 years after treatment.
For cases involving a Breslow depth greater that 0.75 mm or local lymph node spread, In addition to periodic detailed status reports, an MRI of the brain will also be required at intervals determined by the class of medical application requested. For first and second-class medical certificates, the MRI will be required every six months. Third class certification will be needed every twelve months.
If there is distant lymph node spread or metastasis to other systems excluding the brain, the FAA will withhold certification for three (3) years. If, after that time, medical certification is granted, a current status report and MRI will be required every three months for five years.
Applicants with a history of brain metastasis will be disqualified for 5 years, after which time a current status report and MRI will be required every three months.
The FAA will require the following records:
After initial certification by the FAA, subsequent renewals may qualify for AME Assisted Special Issuance (AASI), a program that allows aviation medical examiners to reissue an airman medical certificate under a special issuance authorization. The authorization letter will allow the examiner to reissue the medical certificate if the applicant provides:
The examiner should defer to the AMCD or Region if:
A Special Issuance or AASI is required for any metastatic melanoma regardless of Breslow level. A Special Issuance or AASI is required for any melanoma which exhibits Breslow Level > .75 mm with or without metastasis. A melanoma that exhibits a Breslow Level < .75 mm that has no evidence of metastasis may be issued without an authorization.
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Updated August 24, 2015