Diagnostic Assessment — Back - Solar Keratosis
Example 1 of 1 · fictitious patient (Veteran B)
Diagnostic Assessment
Back - Solar Keratosis (M011)
ADF History
The veteran served in the Australian Defence Force from 05 Mar 1989 to 21 August 2018. His service included both warlike and non-warlike deployments from 05 Mar 1989 to 30 May 2007, followed by additional periods of service from 01 June 2007 to 28 February 2013 and 29 February 2013 to 21 August 2018.
Occupational History
As a member of a signals unit and working in intelligence roles in the ADF, the veteran would have been exposed to significant amounts of solar radiation. Military service often involves extended periods outdoors for training exercises, operations, and physical training, particularly in Australia's high-UV environment. Even intelligence roles require participation in field exercises, outdoor training, and maintenance of physical fitness, all of which involve sun exposure. Military uniforms often leave the back of the neck exposed, and during physical training in hot weather, personnel may train with minimal upper body clothing, exposing the back to direct sunlight.
History
The veteran has a history of solar keratosis on his back, which he has had since 2002, with more recent lesions developing on his head. The condition is directly related to cumulative sun exposure during his military service.
Timeline
- 2002: Initial development of solar keratosis on the back. He has had solar keetarosis on back and then on head recently since 2002 [DIA5 CIA1-3 INTAKE.docx]
- Recent years: Development of additional solar keratosis on the head. He has had solar keetarosis on back and then on head recently since 2002 [DIA5 CIA1-3 INTAKE.docx]
Symptoms
The veteran has solar keratosis lesions on his back and more recently on his head. He seeks medical attention from his GP when he has lesions of concern. The condition is managed with regular skin checks and treatment as needed. There have been no treatment episodes in the last 12 months, and there are no noticeable scars from previous treatments. There is no indication of progression to more severe forms of skin cancer.
Imaging
No specific imaging studies for the solar keratosis condition are mentioned in the provided documents, which is consistent with the typical diagnostic approach for this condition, which relies primarily on clinical examination.
1. What is the formal diagnosis of the condition claimed above?
- Back - Solar Keratosis (M011)
ICD-10-AM Code: L57.0
Solar keratosis, also known as actinic keratosis, is a premalignant skin condition caused by excessive exposure to ultraviolet radiation, primarily from sunlight. These lesions appear as rough, scaly patches on sun-exposed areas of the skin and represent areas of disordered cell growth. While most solar keratoses remain benign, they have the potential to progress to squamous cell carcinoma (a form of skin cancer) in a small percentage of cases, which is why monitoring and appropriate treatment are important.
The condition develops due to cumulative damage from UV radiation over years of sun exposure. Fair-skinned individuals who burn easily, those with outdoor occupations or recreational activities, and people living in high-UV environments (such as Australia) are at increased risk.
The veteran has solar keratosis lesions that developed on his back beginning in 2002, with more recent lesions developing on his head, consistent with areas that would have been exposed to sunlight during his military service.
2. For each diagnosis identified, please also provide the following dates:
When did the veteran first experience symptoms attributable to this condition? The veteran first experienced symptoms attributable to this condition in 2002, as documented in the intake records [DIA5 CIA1-3 INTAKE.docx].
When did the veteran first present to a health / medical provider for this condition? While the exact date of first presentation is not explicitly stated, the intake records indicate that the veteran sees his GP when he has lesions of concern, suggesting that he has been receiving medical attention for this condition since its onset in 2002 [DIA5 CIA1-3 INTAKE.docx].
When was the condition confirmed / formally diagnosed? The condition was formally diagnosed in 2002 when solar keratosis was identified on his back [DIA5 CIA1-3 INTAKE.docx].
When did the veteran first present to you (or your practice) for this condition? August 14, 2023
3. How was this diagnosis confirmed? i.e. what were the key symptoms and signs, investigation results, specialist opinions? Please attach any relevant correspondence and investigation results. The diagnosis of solar keratosis was confirmed based on:
- Clinical history documenting the development of solar keratosis on the back since 2002 and more recently on the head [DIA5 CIA1-3 INTAKE.docx]
- Clinical evaluation by the veteran's GP, who manages the condition and performs skin checks when the veteran presents with lesions of concern [DIA5 CIA1-3 INTAKE.docx]
- The typical presentation of solar keratosis as rough, scaly patches on sun-exposed areas (back and head in this case)
- Additionally, on 15 August 2021, the treating doctor documented a skin lesion on the left forearm, described as "L 1 left forearm dorsal skin lesion Likely to be nodular BCC" [Dr referral LForearm-SkinLesion-BCC.pdf], suggesting ongoing surveillance for related skin conditions
The diagnosis was likely made based on clinical appearance, which is often sufficient for diagnosing solar keratosis. In some cases, a skin biopsy may be performed to confirm the diagnosis or to rule out more serious conditions, but details of such procedures are not mentioned in the available documentation.
4. What do you consider to be the cause(s) of the condition in this veteran? Give consideration to constitutional and common risk factors, pre-existing injuries or diseases, and occupational or lifestyle risks, as well as direct causative mechanisms.
having sunlight exposure to unprotected skin at the affected site for at least 4500 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical onset of solar keratosis MET
- The veteran served in the Australian Defence Force for approximately 29 years (1991-2020), including periods of warlike and non-warlike service.
- Military service involves significant outdoor activities including training exercises, field operations, physical training, and daily duties.
- Even in intelligence roles, personnel are required to maintain physical fitness through outdoor PT sessions and participate in field exercises.
- Over his nearly three decades of service, particularly in Australia's high-UV environment, it is reasonable to conclude that he would have accumulated well over 4500 hours of sunlight exposure to unprotected skin.
- Military uniforms may leave the back exposed during certain activities, particularly during physical training in hot weather when personnel may train with minimal upper body clothing.
- The development of solar keratosis on the back and head is consistent with sun-exposed areas during military service.
Sequelae Solar keratosis is a premalignant condition that can progress to squamous cell carcinoma in a small percentage of cases. While no such progression is noted in the veteran case, ongoing surveillance is important.
Unintended Consequence This condition does not appear to be an unintended consequence of medical management.
The % contribution of the causes is 100% and significant.
5. Please provide a Health Summary and a medication / prescribing history. -see attached report
