Profiling the malignant melanoma sites and melanoma for 25 years of DoW pilots and aircrew.
Principal Investigator
Name
Bradley Williams
Degrees
M.D.
Institution
60 MDG Clinical Investigation
Position Title
Director, Space Medicine Research
About this CDAS Project
Study
MACS
(Learn more about this study)
Project ID
2026-0132
Initial CDAS Request Approval
Nov 4, 2026
Title
Profiling the malignant melanoma sites and melanoma for 25 years of DoW pilots and aircrew.
Summary
Melanoma is responsible for nearly 80% of skin cancer-related deaths [1-2]. Its aggressiveness is attributed to several factors, including immune evasion, proximity to vascular structures, high angiogenic potential, and its inherently mesenchymal nature, contribute to a heightened risk of metastasis and mortality [3-4]. Incidence and mortality risk are influenced by variables such as age, sex, anatomical site, tumor thickness, histologic subtype, and occupation [5-6]. Studies imply a twofold increase in melanoma-related mortality among pilots compared to the general population [7].
The first Occupational Flight Exposure and Cancer Risk Symposium in Houston, TX, 3-4 March 2025 between the USAF, NASA and MD Anderson concluded that the direct link between flying airlines and contracting melanoma was unclear. Melanoma has been shown to occur in both sun-exposed and non-sun-exposed regions, indicating that more factors are at play than environmental ultraviolet light. The meeting noted that the increase in melanoma found for pilots was not accompanied by any appreciable decrease in mortality [8]. While the increases in military pilot melanoma cases could be attributed to the military providing greater access to healthcare and screening, there was no corresponding decrease malignant melanoma mortality among pilots. Several other studies have noted the same trend in pilots and airline personnel [9-11]. Whatever the causal link or links are, there appears to be a real association between flying and melanoma.
The discussion over what this type of association could mean were compounded by the diversity of melanoma case types. Current studies linking melanoma cases to aviation do not describe the case distribution between different types of melanoma. Nationally, 70% of melanoma cases are the superficial spreading type, 15-30% are nodular melanomas and 10-15% are lentigo maligna melanoma [1,3,12,13]. Ultraviolet light would only be expected to produce melanoma cases in sun-exposed areas and current studies do not describe the location sites of these melanoma cases. We would like to utilize the data collected for this study to better characterize demographic, airframe type, melanoma presentation site and melanoma type in Air Force pilots, which could identify areas for further study going forward in the prevention and detection of malignant melanoma in aviation personnel.
Melanoma represents a significant occupational hazard for pilots and aircrew, with an incidence twice that of the general population. Without early detection, metastatic melanoma is often fatal. Although mortality rates have improved over the past decade due to advances in therapy, survival rates remain suboptimal and incidence continues to rise. Unpublished NASA research concluded that astronauts also demonstrated significantly higher melanoma mortality than expected and attribute this link to prior Air Force pilot exposure. NASA found all astronaut melanoma deaths occurred in white males with prior military aviation experience [14]. The limited research focused on Air Force pilots, combined with the rising incidence and plateauing of therapeutic advancements, increases their risk of mortality. This study aims to characterize the patterns and distribution of melanoma within the DoD pilot and aircrew community, thereby informing standards of care and promoting further investigation into occupational exposures that may increase risk.
Aims
Aim 1: To characterize exposure patterns and the location of melanoma. We will assess the patterns of airframe (as reported by AFSC code at the time of diagnosis) with the anatomical locations of the melanoma cases (e.g. face, trunk, arm, leg, orbit, etc).
Aim 2: To describe melanoma, Hodgkin and non-Hodgkin lymphomas, and multiple myeloma in the pilot population. We will characterize age, racial, ethnic, sex compositions of pilots at the age of diagnosis, as well as type of pilot and type of aircraft flown, and number of flight hours if available (or a proxy such as years as a pilot).
Aim 3: To describe the type and behavior of melanoma cases we will characterize the tumor pathology of pilot melanoma patients and describe any associated secondary malignancies.
Collaborators
Bradley Williams (60 MDG Clinical Investigation)
Christin DeStefano (National Military Medical Center)
Liem Phan (60 MDG Clinical Investigation Facility)