A light aircraft crashed and burned shortly after take-off, killing everyone on board, including the pilot and nine people who had spent the day working at a skin cancer clinic in a remote community.
The twin-engine Beech King Air A-100 crashed shortly after take-off from Canyonlands Field airport, 18 miles north west of Moab, Utah, on Friday night, local time.
It hit the ground in nearby hills, flattened and exploded on impact, authorities said.
Emergency crews rushed to the site to search for possible survivors and fight a brush fire that was apparently sparked by the crash.
On board were employees of a Southwest Skin and Cancer/Red Canyon Aesthetics & Medical Spa, a dermatology company based in Cedar City, 200 miles to the west, that travelled to remote areas to provide treatment for skin cancer and other ailments where it might otherwise be unavailable.
They had flown into the tourist town of Moab earlier on Friday - among nine regular stops the team made throughout Utah, northern Arizona and Nevada.
Rescue crews sifted through the wreckage on a small rise about two miles from the runway. Bodies were placed in body bags and carted away.
Grand County Sheriff James Nyland identified those killed as pilot David White; the company's director, Dr Lansing Ellsworth, 50, and his son Dallin, 23; David Goddard, 60, and his daughter Cecilee, 31; Mandy Johnson; Marcie Tillery, 29; Valerie Imlay, 52; Keith Shumway, 29; and Camie Vigil, 25.
"It is with disbelief that we struggle to comprehend the events of yesterday," the Ellsworth family said in a statement last night.
Those from the company "provided much needed dermatology care to patients who might otherwise go without", they said.
The plane was owned by Leavitt Group Wings, part of the Cedar City-based Leavitt Group, an insurance brokerage. The dermatology group had a timeshare agreement for use of the plane, said chief executive Dane Leavitt.
Pilot Mr White was a Leavitt Group Wings employee, Mr Leavitt said.
"He was very well qualified. He'd flown that plane for hundreds of hours. He'd flown this route many times," he said.
The plane was built in 1975 and was well maintained, Mr Leavitt said. His company had owned it for six years.
Moab is about 245 miles south east of Salt Lake City.