Skin in the Game: What Pilots Need to Know About Skin Cancer and UV Risks

Summer Skies, Sun Safety, and Pilots

With summer skies overhead, it’s the perfect time to spotlight a topic that affects all aviators: the sun and its impact on your skin.

As a physician who performs flight physicals and cares for pilots across the spectrum, I often discuss the unique dermatologic risks associated with aviation. Chief among them is the heightened risk of skin cancer due to ultraviolet (UV) radiation exposure at altitude.

This issue is personal for me: I’ve had multiple basal cell carcinomas removed. Growing up in sunny South Florida during the 1980s and ‘90s, I fell victim to the tanning trends of the time. But even without deliberately seeking the sun, pilots are exposed to elevated UV levels just by doing their job.

UV Radiation at Altitude

Most aviators are surprised to learn that UV radiation intensifies with altitude, increasing by roughly 10% to 12% for every 3,280 feet gained. At some cruising altitudes, that can more than double your exposure compared to ground level.

While aircraft windows typically block UVB rays, UVA rays – which penetrate deeper into the skin and are linked to both aging and cancer – can still make it through many cockpit windshields.

Types of Skin Cancer in Pilots

Basal cell carcinoma (BCC), the most common form of skin cancer, tends to affect sun-exposed areas like the face, scalp, ears, and neck. It grows slowly but can cause significant local damage if not addressed. I’ve diagnosed many pilots, both professional and recreational, with BCC after they noticed persistent, non-healing spots.

Squamous cell carcinoma (SCC) is another UV-related concern, often appearing as rough, scaly patches or nodules that may crust or bleed. SCC can be more aggressive than BCC and carries a greater risk of spreading.

The most dangerous, though less common, is melanoma. This aggressive skin cancer is responsible for the majority of skin cancer-related deaths. Pilots, unfortunately, are not exempt. Multiple studies – including one in JAMA Dermatology – show airline pilots have more than double the melanoma risk of the general population.

Incredibly, just 56.6 minutes at 30,000 feet exposes a pilot to as much UVA radiation as a 20-minute tanning bed session. The risk intensifies over reflective surfaces like snow or cloud tops, which can bounce up to 85% of UV rays back toward the aircraft.

Additionally, actinic keratoses – dry, scaly patches resulting from cumulative sun exposure – are common among pilots. Though not cancerous themselves, they can progress to SCC if untreated. I frequently find these during routine exams, and early treatment is key.

Sun Safety Checklist for Aviators

Given these risks, I urge pilots to take UV protection seriously, even inside the cockpit. Whether you’re flying a Cessna 172 or commanding an Airbus A380, sun safety should be part of your checklist:

• Use broad-spectrum sunscreen (SPF 30+)

• Re-apply every two hours on long flights

• Wear a cap or hat, if compatible with your headset

• Install UV-blocking screens or shields if your aircraft lacks protective glass

• Schedule yearly skin exams with a dermatologist

• Regularly inspect your skin for new or changing lesions

Final Thoughts

Skin cancer is often highly treatable when detected early, but prevention is even more powerful. Pilots are trained to assess and mitigate risk in flight; the same vigilance should apply to their health.

As your AME, I’m here to keep you safe: not just in the skies, but on the ground, too.

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