黑色素癌之航空醫學考量及缺點免計探討

The Waiver Considerations of Melanoma

江瑜軒(Yu-Xuan Jiang) ； 林大幃(Ta-Wei Lin) ； 莊文聿(Wen-Yu Chuang) ； 陳珈合(Chia-Ho Chen)

《中華民國航空醫學暨科學期刊》 32卷1&2期 (2018/12) Pp. 67-76

https://doi.org/10.7011/JAMSROC.201812_32(1_2).0008

摘要

黑色素癌在所有皮膚惡性腫瘤之發生率排名第三，且在我國之發生率較西方國家為低，但其具有高惡性度以及高復發性，讓其須被重視之程度不亞於基底細胞癌與鱗狀上皮細胞癌。其癌症特性在於一旦侵犯深度大或是有淋巴結轉移，極易發生遠處轉移，特別是具有中樞神經轉移的特性。治療方面，腫瘤在早期即需要接受大範圍的根除性切除，來預防日後之復發，腫瘤侵犯越深，其切除範圍也越大。在航空醫學上，飛行員可能因為在高空環境而接受較多紫外線，因此在罹患黑色素癌的機率較常人高。而黑色素癌容易轉移至中樞神經的特性，造成如癲癇的症狀，更使得其成為飛行安全考量的重要因素。另外，黑色素癌的治療需要大範圍的切除，容易造成飛行員往後操作飛機或是穿著飛行裝備上的困難。如果沒有轉移或是因大範圍切除造成組織缺陷者，如果沒有影響飛行任務，日後是可以考慮缺點免計的，而免計條件又因為不同癌症分期有所差別，若是癌症分期較後期者，需要停飛觀察的時間就越久，免計標準也更嚴格。飛行員在回到飛行線之前，須要經過長時間的追蹤，依據不同疾病分期有不同的追蹤頻率及時間長度，另外，腦部核磁共振檢查格外重要，以排除在飛行時因有腦部轉移造成的危害。良好的追蹤計畫才能幫助飛行員在回到飛行線上繼續發揮所長，讓飛行員在罹病後仍然能在合理的條件下回復到飛行任務是航醫們重要的任務。

關鍵字

黑色素癌 ； 中樞神經轉移 ； 疾病追蹤 ； 航空醫學 ； 缺點免計考量

並列摘要

Although the incidence of melanoma ranked third of all dermatological malignancy and the incidence in Taiwan is lower than that of westerns countries, we still pay much attention to melanoma no less than basal cell carcinoma and squamous cell carcinoma owing to it's high malignant tendency and high recurrence rate. Once wide and deep invasion or when regional lymph nodes are involved, the possibility of distant metastasis, especially central neural system, would significantly increase. As to treatment, radical resection might be suggested to prevent recurrence in the future. Airplane pilots might be exposed to relatively high dose of ultraviolet in the high altitude environment, which might increase their risk of developing malignant melanoma. In consideration of flight safety, it's important to emphasize that the tendency for malignant melanoma to metastasize to central neural system which would cause seizure or other neurological deficits. In addition, for pilots whose malignant melanoma is located in critical position such as hands and undergo wide cutaneous excision, they may have difficulty in vehicle manipulation, limited motions at wound site. If there is no metastasis or tissue defect resulted from wide resection, and the function of the pilot is not affected, waiver might be considered. However, the criteria of waiver are separated by different stages of malignant melanoma. In patients with advanced clinical stage, it would need a longer period of observation than those in early stages. Before airplane pilots back to work with normal efficiency, they should undergo long-term and regular follow up with to the duration depending on different clinical stage of malignancy. In order to prevent the possibility of neurological deficits resulting from brain metastasis, neurologic imaging such as brain MRI should be included in the checking list during follow up. A well-planned follow up schedule could help pilots with malignant melanoma after completing treatment to get back to work without potential risk. This is our most important mission as flight surgeons.

並列關鍵字

melanoma ； CNS metastasis ； disease monitoring ； aeromedical evaluation ； waiver consideration