Diagnostic Assessment — Malignant Melanoma - Trunk
Example 1 of 1 · fictitious patient (Veteran U)
Diagnostic Assessment
Malignant Melanoma - Trunk
SOP Codes: Reasonable Hypothesis (RH): Statement of Principles concerning Malignant Melanoma of the Skin (Reasonable Hypothesis) (No. 34 of 2024) Balance of Probabilities (BOP): Statement of Principles concerning Malignant Melanoma of the Skin (Balance of Probabilities) (No. 35 of 2024)
ADF History
The veteran, Aviation Technician (Avtech), enlisted Mar 1983, discharged 2018.
Occupational History
As an Aviation Technician in the RAAF, the veteran was exposed to significant occupational hazards including prolonged solar radiation exposure during outdoor work on flight lines, exposure to aviation turbine fuel and hydrocarbons, solvents, cleaning agents, hydraulic fluids, and paints. His role involved maintenance of sophisticated RAAF aircraft in hangars and on flight lines, requiring work in various environmental conditions with substantial sun exposure throughout his career.
History
The veteran an RAAF Aviation Technician, was diagnosed with malignant melanoma of the trunk on 29 February 2014. The condition likely resulted from prolonged occupational sun exposure during his military service from 1986 to 2018, working extensively on outdoor flight lines and aircraft maintenance areas.
Timeline
- 29 Feb 2014: The veteran was diagnosed with malignant melanoma of the trunk. The clinical presentation details were not documented in the available records, but this marked the formal diagnosis date. The condition was likely detected through routine skin examination or following patient concerns about a skin lesion. No specific symptoms or circumstances of discovery were detailed in the medical records.
- 14 Dec 2014: The melanoma diagnosis was recorded in comprehensive health records, confirming the ongoing status of malignant melanoma. This administrative documentation maintained the formal record of his condition for medical management and compensation purposes.
- 09 Jul 2015: A PET-CT scan showed no convincing evidence of any recurrent or metastatic melanoma. This imaging was performed as part of disease surveillance and monitoring, indicating the melanoma was under control with no evidence of spread or recurrence at the time of examination.
Symptoms
The initial symptoms of the melanoma were not specifically documented in the available records. Current symptoms as of the recent medical assessments show no evidence of active disease or recurrence, with the PET-CT scan demonstrating successful disease control.
Imaging
- 09 Jul 2015: PET-CT scan revealed no convincing evidence of any recurrent or metastatic melanoma, demonstrating disease control and absence of metastatic spread.
1. What is the formal diagnosis of the condition claimed above?
Malignant Melanoma of the Trunk - DVA SOP codes: RH No. 34 of 2024, BOP No. 35 of 2024, ICD-10 code: C43.59
Malignant melanoma is a malignant neoplasm arising from melanocytes, the pigment-producing cells in the skin. It represents the most serious form of skin cancer due to its potential for rapid growth and metastasis. Melanoma can occur anywhere on the body but commonly affects sun-exposed areas. The trunk is a frequent location, particularly in males. Risk factors include ultraviolet radiation exposure, fair skin, multiple moles, family history, and immunosuppression. Early detection and treatment are crucial for prognosis, with surgical excision being the primary treatment for localized disease.
2. For each diagnosis identified, please also provide the following dates:
When did the veteran first experience symptoms attributable to this condition? The specific onset of symptoms is not documented in the available medical records.
When did the veteran first present to a health/medical provider for this condition? The veteran first presented for this condition on 29 February 2014, when the malignant melanoma was diagnosed. The specific healthcare provider details are not documented in the available records.
When was the condition confirmed/formally diagnosed? The condition was confirmed and formally diagnosed on 29 February 2014. The diagnostic method (clinical examination, biopsy, histopathology) and diagnosing physician details are not specified in the available records.
When did the veteran first present to you (or your practice) for this condition? 23 Apr 2015
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 malignant melanoma of the trunk was confirmed on 29 February 2014, though the specific diagnostic methodology is not detailed in the available records. The diagnosis was likely confirmed through histopathological examination following biopsy or excision of a suspicious skin lesion. A PET-CT scan performed on 09 July 2015 for disease surveillance showed no evidence of recurrent or metastatic disease, confirming successful treatment and disease control.
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.
RH Factor 1: having at least 5 sunburns at the affected site at least 2 years before clinical onset - This factor is MET. The veteran worked extensively on outdoor flight lines as an RAAF Aviation Technician from 1986 to 2018, involving significant solar radiation exposure that would have resulted in multiple sunburns over his 32-year career.
RH Factor 3: having sunlight exposure to unprotected skin for a cumulative period of at least 2,250 latitude equivalent hours before clinical onset - This factor is MET. Based on detailed calculations from his service history, the veteran weighted sunlight exposure was calculated assuming 6 hours per day outdoor exposure, 5 days per week, 48 weeks per year (1440 hours annually) based on his Aviation Technician role involving flight line work. His posting history across multiple RAAF bases included: the RAAF base (27.6°S, weighting factor 0.75), the RAAF base (34.7°S, weighting factor 0.75), the RAAF base (35.1°S, weighting factor 0.5), the RAAF base (33.6°S, weighting factor 0.75), and RAAF Williams the base (37.8°S, weighting factor 0.5). Over his 32.5-year service period, with approximately 19.5 years at 0.75-weighted bases (21,060 weighted hours) and 13 years at 0.5-weighted bases (9,360 weighted hours), his total weighted sunlight exposure was approximately 30,420 latitude equivalent hours, significantly exceeding the required 2,250 hours.
BOP Factor 1: having at least 5 sunburns at the affected site at least 5 years before clinical onset - This factor is MET. The same occupational solar radiation exposure that meets the RH criterion also satisfies this higher threshold requirement for BOP.
BOP Factor 2: having sunlight exposure to unprotected skin for a cumulative period of at least 4,500 latitude equivalent hours before clinical onset - This factor is MET. His calculated 30,420 latitude equivalent hours of sunlight exposure substantially exceeds the required 4,500 hours for the Balance of Probabilities standard. This calculation accounts for the varying UV intensity at different latitudes where he was posted throughout his career, with the weighted calculation methodology ensuring accurate assessment of cumulative solar radiation exposure across his service locations.
RH/BOP Factor 18/10: inability to obtain appropriate clinical management for malignant melanoma of the skin before clinical worsening - This factor is NOT MET. The melanoma was diagnosed and managed appropriately with current imaging showing no evidence of recurrence or metastasis.
Sequelae
This condition is not a sequelae of another known service-related condition.
Unintended Consequence
This condition is not an unintended consequence of ADF medical treatment, as there is no evidence of prior medical treatment that contributed to the development of melanoma.
Inability to Attain Appropriate Medical Management
There is no evidence of inability to attain appropriate medical management for this condition. The melanoma was diagnosed promptly and managed effectively, with current surveillance showing disease control.
The % contribution of the causes is 100% and significant.
5. Please provide a Health Summary and a medication/prescribing history.
-see attached report
