Fly Well

Skin in the game

April 1, 2010

Which is your largest organ? Stop giggling. It’s your skin, which prevents other organs from falling out and provides a canvas for witty T-shirts and cool leather jackets.

Having brushed your teeth and shaved this morning, what else did you do? Stop laughing! Our female readers probably did this; the rest of you probably did not—apply sunscreen.

When not flying we either putter about the airport or, as an AOPA survey demonstrated, are most likely camping, fishing, hiking, or participating in other outdoor activities—all of which place us under the sun. And then there is flying. The sun produces ultraviolet light, an invisible part of the electromagnetic spectrum divided into three wavelengths: UVA (long wave, subdivided into UVA I and II); B (short wave); and C, which is absorbed by the ozone layer—while we still have one. The higher you go, the more ultraviolet you encounter.

Ultraviolet damages the skin, causing that tanned, leathery look that can progress to skin cancer. With roughly one million skin cancers a year in the United States and someone dying from melanoma every hour, this is a serious problem. The most common is basal cell carcinoma (BCC), which often looks like a pearly, round bump; small blood vessels in the edge maybe with a central crater. This is often called a “rodent ulcer,” but there is nothing Mickey Mouse about BCC—it grows by gnawing into the local tissue like a rat. Occurring anywhere, it is often found between the edge of the mouth and the ear. Thankfully, BCC can often be completely cured by local therapy.

The second type of malignancy is squamous cell carcinoma. It is nastier, often requiring surgery and other treatment as it can spread around the body. It looks like either an ulcer or a cauliflower-like mass surrounded by inflammation that grows and bleeds.

Melanocyte cells produce skin pigment that cluster to form moles; they have the potential to turn into the most wicked form of skin cancer, melanoma. Rare before puberty, melanoma is more common in sunny climes and on exposed parts of the body. Hairy moles tend to be safer, unless very large. Be aware of change—a rapidly growing, inflamed, bleeding mole or one that changes color. These tumors spread widely and quickly and to enable success, treatment must be swift.

What of the UV bathing the cockpit? In most piston-engine aircraft, your world view comes through stretched acrylic, which is also used for some jets with curved windows; those with flat windows tend to use glass. No manufacturer I spoke to could categorically state what percentage of ultraviolet is absorbed by its optics. In fact, there was a lot of disagreement, although some coatings may interfere with the passage of UV—so may sodium or iron in the glass.

A growing body of research in airline and military pilots shows an increased risk of skin and other cancers for aviators. Other factors may be at play, such as sleep deprivation or stress—but why take a chance? At high altitude other forms of radiation may also add to the risk profile.

To prevent becoming a statistic we can learn from Sid the Seagull, mascot for a campaign developed by our Antipodean brethren. In response to the high incidence of skin cancer in Australia, they introduced an initiative called “slip (on a shirt), slop (on sunscreen), slap (on a hat).” They later added seek (shade) and slide (on sunglasses—UV also damages the eyes). I recommend following Sid’s guidance as well as wearing ultraviolet-proof clothing and maybe applying UV-absorbent film to the cockpit glass.

Once a month, admire your naked self in front of a mirror—will anyone else? Know your moles and if you notice change or anything unusual, see a physician promptly. Apply sunscreen daily to potentially exposed body parts—and especially your face, neck, ears, and arms. A product’s sun protection factor (SPF) represents how much longer it will take for skin to burn (SPF 20 takes 20 times longer than unprotected skin).

The Skin Cancer Foundation recommends using SPF 15 or above, which removes about 93 percent of UV rays; SPF 45 cuts close to 98 percent. Sunscreens might cause vitamin D deficiency, which in theory can predispose a person to cancer, but this does not seem to be a significant problem.

Consider a regular checkup from a dermatologist or other doctor. There are also machines that show areas of sun damage on your skin—not only a good screening aid, but reinforcing the need for prudence.

The AOPA Medical Services Plan provides access to WorldDoc, an online resource with plenty of useful information. Keep your eyes open for some other developments from AOPA to help protect you, your family, and passengers from this avoidable disease.

Your skin is so vital in many ways and Hollywood’s Gwyneth Paltrow may have said it best: “Beauty, to me, is about being comfortable in your own skin. That, or a kick-*** red lipstick.” As most pilots (sorry ladies) don’t wear lipstick, let’s keep our skin beautiful and healthy.

E-mail the author at jonathan.sackier@aopa.org.