This protocol applies to cutaneous melanoma.
Aeromedical implications
Effect of condition on aviation
- Overt incapacitation
- Brain metastases can present suddenly with incapacitating symptoms such as seizures, headache, and neurologic deficits.
- Subtle incapacitation
- pain
- depression and affective disorders
- medication side-effects (heart, lungs, liver, kidneys, immune competence)
- Distraction due to treatment and symptoms, for example pain and nausea.
Effect of aviation on condition
- Hypoxia - lowers seizure threshold and thus risk from cerebral secondaries
- Fatigue and jet lag will tend to aggravate any adverse effects of radiotherapy and chemotherapeutic agents
Approach to medical certification
Based on the condition
- Incapacitation risk
- Risk of metastasis
- Absence of symptoms or complications including psychological
Based on treatment
- Adequate clearance
- Completed systemic adjuvant therapy or immuno-oncology drugs (if applicable) and absence of significant side effects.
Demonstrated stability
- May include interim surveillance
Risk assessment protocol - information required
New cases
A report from dermatologist, surgeon or treating doctor with respect to:
- confirmed diagnosis
- stage and subgroup (Based on eighth edition American Joint Committee on Cancer (AJCC) melanoma staging system)
- clinical status:
- presenting symptoms or signs, for example lymphadenopathy
- history of recurrence or metastatic disease
- current clinical status.
- Investigations conducted:
- Results of staging investigations/histology - attach histopathology report if available
- Follow-up investigations.
- Management:
- Treatment (types and dates of treatment)
- Surgery - complete resection with clear margins
- Date of completion of treatment (such as immunotherapy, chemotherapy, or radiation)
- Any further treatment is recommended currently
- Monitoring.
- Prognosis
- Risk of probable future recurrence:
- What are the likely clinical presentations of recurrence?
- Could this be accompanied by incapacitating symptoms?
- Could a recurrence be detected before symptoms occur by increasing the frequency of radiological, haematological, or other surveillance?
- Estimated annualised percentage of overall survival, progression free survival and distant metastases free survival (please provide relevant references) based on the stage and subgroup
- Follow-up plan.
Renewal
A report from dermatologist, surgeon or treating doctor with respect to:
- Current clinical status:
- symptoms/signs
- skin check
- lymph node examination.
- Investigations conducted:
- Follow-up investigations, for example skin excisions, imaging or PET scans, lymph node biopsies.
- Management:
- treatment
- monitoring.
- Prognosis
- Risk of possible future recurrence
- Follow-up plan.