Melanoma

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.

Indicative outcomes

  • Prognostic data from AJCC may be helpful.

Favourable

  • Low risk melanoma - confirmed histology and fully excised.

Unfavourable

  • Metastatic melanoma
  • High-risk melanoma with increased risk of recurrence and brain metastases
  • 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.

Feedback

We value your feedback.

Disclaimer

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

Last updated:
Online version available at: https://www.casa.gov.au//licences-and-certificates/medical-professionals/dames-clinical-practice-guidelines/melanoma
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