Skin Cancer Incidence Among U.S. Navy and Marine Corps Aviators: A Retrospective Cohort Study.

INTRODUCTION: Melanoma and non-melanoma skin cancers (NMSCs) represent significant sources of morbidity among military personnel. Aviation personnel experience unique occupational exposures, including increased ultraviolet (UV) radiation at altitude and potential cockpit-related UV transmission, which may elevate skin cancer risk. Prior civilian and military studies have demonstrated increased melanoma incidence among airline and military pilots; however, contemporary data comparing U.S. Navy and Marine Corps aviation personnel with non-aviation officers within the same service branch remain limited. This study evaluated melanoma and NMSC incidence among active duty Navy and Marine Corps aviators compared with non-aviation commissioned officers from 2016 to 2024.

MATERIALS AND METHODS: A retrospective cohort study was conducted using de-identified outpatient medical encounter data from the Defense Medical Epidemiology Database (DMED). Incident melanoma (ICD-10 C43) and NMSC (ICD-10 C44) diagnoses were identified using first ambulatory encounters. The analytic cohort was restricted to active duty commissioned officers in the Navy and Marine Corps (pay grades O1-O9). Aviation personnel included fixed-wing fighter/bomber pilots, other fixed-wing pilots, and helicopter pilots; the comparison group comprised non-aviation line officers. Annual and pooled incidence rates per 100,000 personnel were calculated using corresponding population denominators. Poisson regression models with log-population offsets were used to estimate crude and age-adjusted incidence rate ratios (IRRs) with 95% confidence intervals (CIs). Statistical significance was defined as P < .05. The use of de-identified administrative data was determined to be exempt from institutional review board oversight.

RESULTS: A total of 467,174 commissioned officers were included, including 185,616 aviators and 281,558 non-aviators. During the study period, 242 incident melanoma cases and 1,430 NMSC cases were identified. Pooled melanoma incidence was 56.0 per 100,000 among aviators and 49.0 per 100,000 among non-aviators (crude IRR = 1.14; 95% CI, 0.89-1.47) and remained non-significant after age adjustment (adjusted IRR = 1.18; 95% CI, 0.91-1.52). In contrast, NMSC incidence was significantly elevated among aviators (357.7 vs. 272.1 per 100,000; crude IRR = 1.32; 95% CI, 1.19-1.46), with persistent elevation after age adjustment (adjusted IRR = 1.42; 95% CI, 1.28-1.57). Absolute incidence increased with age, while the most pronounced relative elevation in melanoma risk was observed among personnel aged 35-39 years.

CONCLUSIONS: Aviation personnel demonstrated a statistically significant elevation in NMSC incidence compared with non-aviation officers, while melanoma incidence was elevated but not statistically significant after age adjustment. These findings suggest a potential occupational contribution to keratinocyte carcinoma risk among military aviators. Strengths of this study include the use of population-level denominators and regression modeling with appropriate exposure offsets; limitations include reliance on administrative diagnostic coding and the absence of detailed exposure metrics such as cumulative flight hours or ultraviolet radiation dose. These results support consideration of targeted occupational risk mitigation strategies and enhanced dermatologic surveillance within military aviation communities. Further longitudinal research incorporating detailed exposure characterization is warranted to clarify potential dose-response relationships and guide force health protection policy.