ITEM 40. Skin

CHECK EACH ITEM IN APPROPRIATE COLUMN NORMAL ABNORMAL

I. Code of Federal Regulations

All Classes: 14 CFR 67.113(b)(c), 67.213(b)(c), and 67.313(b)(c)

(b) No other organic, functional, or structural disease, defect, or limitation that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment relating to the condition involved, finds -

II. Examination Techniques

A careful examination of the skin may reveal underlying systemic disorders of clinical importance. For example, thyroid disease may produce changes in the skin and fingernails. Cushing's disease may produce abdominal striae, and abnormal pigmentation of the skin occurs with Addison's disease.

Needle marks that suggest drug abuse should be noted and body marks and scars should be described and correlated with known history. Further history should be obtained as needed to explain findings.

The use of isotretinoin (Accutane) can be associated with vision and psychiatric side effects of aeromedical concern – specifically decreased night vision/night blindness and depression. These side-effects can occur even after the cessation of isotretinoin. See Aeromedical Decision Considerations.

III. Aerospace Medical Disposition

The following is a table that lists the most common conditions of aeromedical significance, and course of action that should be taken by the AME as defined by the protocol and disposition in the table. Medical certificates must not be issued to an applicant with medical conditions that require deferral, or for any condition not listed in the table that may result in sudden or subtle incapacitation without consulting the AMCD or the RFS. Medical documentation must be submitted for any condition in order to support an issuance of an airman medical certificate.

• CUTANEOUS
• All classes
• (Updated 09/24/2025)

*Notes:

• PSORIASIS
• All Classes
• (Updated 08/27/2025)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Mild to moderate disease confined to the skinANDTreated with topical medication only	If the AME can determine the condition is under control, current medications are acceptable, and no symptoms that would interfere with flight or safety related duties:	ISSUEAnnotate this information in Block 60.
B. Mild to moderate diseaseANDTreated with oral or injectable medicationIf psoriatic arthritis present, see CACI – Arthritis Worksheet	See the CACI - Psoriasis Worksheet.This requires a current, detailed Clinical Progress Note from the treating physician.If the pilot meets all CACI worksheet criteria and is otherwise qualified:	ISSUE Annotate (elements or findings) in Block 60. Annotate the correct CACI statement in Block 60 and keep the required supporting information on file.
C. All others including:• Erythrodermic psoriasis• Pustular psoriasis• Severe psoriasis	Submit the following for FAA review:A current, detailed Clinical Progress Note generated from a clinic visit with the treating Dermatologist or Rheumatologist no more than 90 days prior to the AME exam. It must include:• A detailed summary of the history of the condition;• Current medications, dosage, and side effects (if any);• Physical exam findings;• Results of any testing performed;• Diagnosis;• Assessment and plan;• Prognosis; and• Follow-up.The Clinical Progress Note must specifically include:• If any co-morbid conditions are present• Documentation of counseling on guideline-directed screening for comorbid conditionsSee Pilot Information – Clinical Progress Note.	DEFERSubmit the information to the FAA for a possible Special IssuanceAnnotate (elements or findings) in Block 60.

CACI – Psoriasis Worksheet

(Updated 08/27/2025) To determine the applicant’s eligibility for certification, the AME must review a current, detailed Clinical Progress Note generated from a clinic visit with the treating physician or specialist no more than 90 days prior to the AME exam. If the applicant meets ALL the acceptable certification criteria listed below, the AME can issue. Applicants for first- or second- class must provide this information annually; applicants for third-class must provide the information with each required exam.

AME MUST NOTE in Block 60 one of the following:

[ ] CACI qualified Psoriasis. (Documents do not need to be submitted to the FAA.)

[ ] Has current OR previous SI/AASI but now CACI qualified Psoriasis.

[ ] NOT CACI qualified Psoriasis. I have deferred. (Submit supporting documents.)

• SKIN CANCER
• All Classes
• (Updated 08/26/2015)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
Unknown pathology	If unable to verify pathology, have airman collect: ☐ Medical records describing the diagnosis and treatment; and ☐ Pathology report(s)	MORE INFO NEEDEDOnce reports are received, refer to the appropriate skin cancer diagnosis in this section.
Basal cell cancer (BCC)Squamous cell cancer (SCC)Uncomplicated skin only No organ involvement	AME interview and exam findings consistent with uncomplicated local BCC or SCC completely treated (excised, destroyed, or Mohs procedure) and resolved.	ISSUENote BCC or SCC treated in Block 60.If complicated lesion, see below.
SCC or BCCComplicated lesion Metastatic lymph node or deep tissue involvement, aggressive pathology, or other abnormalitiesAlso see ENT section	Submit the following for FAA review: ☐ Medical records describing the diagnosis and treatment; ☐ Pathology report(s); ☐ Operative notes; ☐ Current, detailed Clinical Progress Note that includes current or planned future treatment and prognosis; and ☐ Copies of any imaging performed (CT/MRI)	DEFER Submit reports to FAA for review.Follow-up certification - based on Special Issuance Authorization.
MelanomaLess than 0.75 mm in depthORMelanoma in Situ	Review: ☐ Medical records describing the diagnosis and treatment; and ☐ Pathology report(s)	ISSUE If complete resection with clear margins, no recurrence, no metastatic disease, and favorable reports.Document in block 60 AND submit reports to FAA for retention in the file.
MelanomaEqual to 0.75 mm or greater in depth	Review and submit the following: ☐ Medical records describing the diagnosis and treatment; ☐ Pathology report(s); ☐ Operative notes; ☐ Current status report that includes if any additional lesions, any metastatic disease, any current or future treatment planned; and ☐ Current MRI brain	DEFER Submit reports to FAA for review.Follow-up certification - based on Special Issuance Authorization.
Metastatic MelanomaORMelanoma of Unknown Primary Origin	Submit the following for FAA review: ☐ Info from Melanoma greater than 0.75 mm above; ☐ PET scan; and ☐ Copies of any additional testing performed by the treating physician.	DEFER Submit supporting documents for FAA review.

• URTICARIAL ERUPTIONS
• All Classes