Diagnostic Assessment — Left Lower Eyelid - Seborrheic Keratosis
Example 1 of 1 · fictitious patient (Veteran M)
Diagnostic Assessment
Left Lower Eyelid - Seborrheic Keratosis
SOP Codes: Balance of Probabilities No. 20 of 2024, Reasonable Hypothesis No. 19 of 2024
ADF History
Name: The veteran, Date of Birth: [withheld] Occupation: Avionics Technician, Enlistment Date: 06 September 2003, Discharge Date: 19 Mar 2019.
Occupational History
As an Avionics Technician in the Royal Australian Air Force, the veteran was exposed to significant occupational sun exposure during aircraft maintenance work. His role required regular outdoor work on aircraft flight lines at RAAF bases, particularly at the RAAF base in the the territory, which is located in the tropical zone at approximately 14.5° South latitude. This geographic location subjects personnel to intense solar radiation throughout the year with minimal seasonal variation in ultraviolet radiation intensity. Avionics technicians routinely work outdoors on flight lines and aircraft surfaces that reflect UV radiation, creating ongoing dermatological exposure risks.
History
The veteran an Avionics Technician in the Royal Australian Air Force, developed a seborrheic keratosis on his left lower eyelid during his military service. The lesion was first formally assessed by a plastic surgeon in July 2010 as part of a comprehensive skin examination that included multiple facial lesions requiring specialist evaluation due to their proximity to sensitive facial structures.
Timeline
- 12 May 2009 - the veteran was assessed by plastic surgeon the treating doctor for multiple facial skin lesions including a lesion on the left lower eyelid. The plastic surgeon performed clinical assessment of the lesion and determined it to be "Seborrheic keratosis". Due to the proximity to the eye and cosmetic concerns, specialist plastic surgical evaluation was deemed appropriate. The lesion was clinically assessed as benign but required formal documentation and consideration for management. This represented the first formal specialist assessment and diagnosis of seborrheic keratosis affecting the left lower eyelid region.
Symptoms
At the time of assessment in July 2010, the veteran presented with a visible skin lesion on the left lower eyelid that was of cosmetic concern. The lesion was clinically assessed by the plastic surgeon as consistent with seborrheic keratosis. From the available medical documentation, there is no specific mention of associated symptoms such as itching, irritation, or bleeding from this particular lesion. The primary concern appeared to be the visible appearance and appropriate clinical assessment given the sensitive facial location.
Imaging
No specific imaging studies were documented for this lesion. The diagnosis was made on clinical assessment by the plastic surgeon.
1. What is the formal diagnosis of the condition claimed above?
Seborrheic Keratosis, Left Lower Eyelid, DVA SOP Code Balance of Probabilities No. 20 of 2024, Reasonable Hypothesis No. 19 of 2024, ICD-10 code L82.
Seborrheic keratosis is a benign intra-epidermal skin tumour arising from the proliferation of basaloid keratinocytes with histopathological architecture of a papilloma with a flat base and a hyperkeratotic crown. These lesions are among the most common benign skin tumours in adults, typically appearing as well-demarcated, waxy, "stuck-on" papules or plaques. They are strongly associated with chronic sun exposure and increase in frequency with age. The lesions are typically brown to black in colour, though they can range from flesh-coloured to very dark, and have a characteristic warty or velvety surface texture.
2. For each diagnosis identified, please also provide the following dates:
When did the veteran first experience symptoms attributable to this condition? The exact onset date is not documented, but the lesion was present by July 2010 when first assessed [CLAIMS.pdf Page 63].
When did the veteran first present to a health / medical provider for this condition? 12 May 2009 - The veteran was assessed by plastic surgeon the treating doctor for multiple facial lesions including the left lower eyelid seborrheic keratosis [CLAIMS.pdf Page 63].
When was the condition confirmed / formally diagnosed? 12 May 2009 - The condition was diagnosed by plastic surgeon the treating doctor during clinical assessment [CLAIMS.pdf Page 63].
When did the veteran first present to you (or your practice) for this condition? 05 Apr 2021.
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 was confirmed by specialist plastic surgeon the treating doctor on 12 May 2009 through clinical assessment [CLAIMS.pdf Page 63]. The key diagnostic feature was the clinical appearance of the lesion consistent with seborrheic keratosis on the left lower eyelid. The plastic surgeon's expertise in dermatological conditions and facial lesions provided the specialist opinion necessary for formal diagnosis. No histopathological examination was documented as being performed on this specific lesion, with the diagnosis based on characteristic clinical appearance.
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 2,250 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones - MET
- The veteran served primarily at the RAAF base (14.5° South latitude) in the tropical zone from November 2004 to May 2020, accumulating 22,320 weighted sunlight hours based on documented outdoor work exposure of approximately half of each shift on the flight line. This significantly exceeds the 2,250-hour threshold required under the SOP.
For the the treating doctor-Trélat sign only, having a malignancy excluding non-melanotic malignant neoplasm of the skin, within 1 year before clinical onset - NOT MET
- This factor only applies to the treating doctor-Trélat sign (sudden onset of >20 new seborrheic keratoses within 6 months), which is not applicable to this single lesion presentation.
Taking a course of dabrafenib or vemurafenib for the treatment of cancer within 1 year before clinical onset - NOT MET
- No documentation of the veteran receiving these specific cancer medications in the medical records.
Inability to obtain appropriate clinical management for seborrheic keratosis before clinical worsening - NOT MET
- The lesion was appropriately assessed by a specialist plastic surgeon when identified, with no evidence of inappropriate clinical management or barriers to care.
Sequelae
This condition is not considered a sequelae of another known condition. Seborrheic keratosis is a primary benign skin tumour related to chronic sun exposure.
Unintended Consequence
This condition is not considered an unintended consequence of medical management. No procedures or medications were documented that would have resulted in the development of seborrheic keratosis.
Inability to Attain Appropriate Medical Management
The condition does not meet the criteria for inability to attain appropriate medical management. The veteran was appropriately assessed by a specialist plastic surgeon when the lesion was identified in 2011. There is no evidence of barriers to healthcare access or inappropriate management that would have led to permanent worsening of the condition. The Full Federal Court in Brew v Repatriation Commission (01 May 1996) establishes that "inability" encompasses both objective and subjective barriers to treatment, but in this case, appropriate specialist care was provided in a timely manner.
The % contribution of the causes is 100% and significant.
5. Please provide a Health Summary and a medication / prescribing history.
-see attached report
