Melanoma

Guidance for medical examiners when assessing a patient for either a general topic or condition - Melanoma.

Aeromedical implications

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

Effect of condition on aviation

  • Overt incapacitation
    • seizure risk is major hazard
  • Subtle incapacitation
    • pain
    • depression and affective disorders
    • medication side-effects (heart, lungs, liver, kidneys, immune competence)
  • Distraction due to treatment and symptoms e.g. pain and nausea.

Approach to medical certification

Based on the condition

  • Incapacitation risk
  • Risk of metastasis
  • Absence of symptoms / complications including psychological

Based on treatment

  • Adequate clearance

Demonstrated stability

  • May include interim surveillance

Risk assessment protocol - information required

New cases

  • Confirmed diagnosis
  • Clinical status
    • presenting symptoms/signs eg lymphadenopathy
  • Investigations conducted
    • Results of staging investigations/histology
    • Follow-up investigations
  • Management
    • treatment
    • monitoring
  • Prognosis
  • Risk of possible 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?
  • Follow-up plan.

Renewal

  • Current clinical status
    • symptoms/signs
    • skin check
    • lymph node examination
  • Investigations conducted
    • Follow-up investigations eg skin excisions, imaging/ PET scans, lymph node biopsies
  • Management
    • treatment
    • monitoring
  • Prognosis
  • Risk of possible 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?
  • Follow-up plan.

Indicative outcomes

Prognostic data from AJCC may be helpful

Favourable

  • Low risk melanoma - confirmed histology and fully excised

Unfavourable

  • Metastatic melanoma
  • Melanoma with an unacceptable risk of metastasis
  • Melanoma requiring radiotherapy or chemotherapy

Pilot and controller information

  • It is very important to provide the laboratory report about any skin lumps or moles removed. This provides the base information to enable an assessment
  • CASA may require annual dermatologist or GP reports for 5 years following treatment for low risk melanoma
  • Applicants with unacceptable metastasis risk may not meet the required standard for medical certification
  • Multi-crew restriction may be applied in some cases depending on risk of metastasis

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Disclaimer

The clinical practice guidelines is provided by way of guidance only and subject to the clinical practice guidelines disclaimer.

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