Clinical Topics   /   Oncology

Air Force Battles Malignant Melanoma with Enhanced Prevention, Detection, Treatment

By US Medicine

By Stephen Spotswood

LACKLAND AIR FORCE BASE, TX – One of the most common cancers among active-duty troops, malignant melanoma was diagnosed in 1,788 servicemembers between 2000 and 2011.1

Because military personnel often are required to be outside for prolong periods of time, increasing the risk of sun exposure, they might be expected to have higher rates of the cancer than the general population. Yet, that is not always the case. Young white males in the armed forces actually have a lower incidence of melanoma than the general population, according to a U.S. Military Cancer Institute study from 1990 to 2004. 2

(Malignant melanoma is far more common in Caucasians than in other races; of the 1,788 military cases between 2000 and 2011, only 129 were in nonwhites.)

On the other hand, rates for older servicemembers are as high or higher than the general population. More than 72% of the malignant melanoma cases were in servicemembers 30 years old or older, according to the June 2012 report from the Armed Forces Health Surveillance Center.

“In general, the strongest demographic correlate of increased risk of a cancer diagnosis was older age,” the authors wrote.

Maj. Wendie Wohltmann, 81st Medical Operations Squadron dermatologist, examines a lesion for possible skin cancer on Robert Fell, a retired captain, in the dermatology clinic. Age is a risk factor for malignant melanoma and other skin cancers. U.S. Air Force photo by Steve Pivnick

Focus on Prevention

That disparity might have much to do with the services’ increased focus on preventing melanoma in recent years. The Air Force has a slightly higher rate of melanoma than the services in total — 15.5 vs. 10.5 — but it also has a range of measures in place to protect its airmen from skin cancer, from very simple preventive measures to cutting-edge pharmaceutical treatments.

The first goal is to cut down on unnecessary exposure to sunlight and keep the development of melanoma and its warning signs to a minimum. Before deployment, troops are instructed about sun safety. None are deployed before being issued sunscreen, and mandatory hat wear has been in place since the 1960s. Pilots and navigators also are protected from the higher levels of radiation they could be exposed to in the upper atmosphere.

The second goal is to catch all melanomas as early as possible.

“We screen aviators and those with flying status on a yearly basis, and flight surgeons screen them with a general skin exam,” explained Lt. Col. Todd Kobayashi, MD, the Air Force Surgeon General Consultant for Dermatology.

The American Academy of Dermatology (AAD) recommends a yearly screening exam for every adult, and servicemembers are asked to screen themselves on a yearly basis.

“We ask they do it on their birthday, so it’s easy to remember — birthday suit screening exams,” Kobayashi said. “You strip down and screen yourself, looking for atypical moles.”

While such moles are rarely malignant themselves, people who develop them are at an increased risk of developing melanomas.

The Air Force also tries to screen its retired population — who, being older, are at a higher risk for skin cancers — at least once a year.

Some of the barriers to success have been societal rather than medical. When the AAD rolled out its melanoma-prevention initiatives, including a campaign against the use of tanning beds, there was a lot of skepticism.

“There was just a lot of pushback in the very beginning when we first told people — general population and servicemembers — to stay out of the sun from a dermatologic perspective. Being in the sun and having a tan was very much in vogue,” Kobayashi said. “But I think the AAD and dermatologists in the Air Force have been pretty successful in manning a campaign against suntanning.”

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