Diagnostic Assessment — Right Forehead - Epidermal Cyst
Example 1 of 1 · fictitious patient (Veteran I)
Diagnostic Assessment
Right Forehead - Epidermal Cyst
No specific SOP exists for epidermal cysts. This condition may potentially be considered under:
- General Skin Disorder SOP (if applicable to service-related skin conditions)
- Soft Tissue Injury SOP (Instrument No. 31 & 32 of 2017) - if related to trauma or occupational factors
ADF History
The veteran, Aircraft Technician (ATECH/AMECH), enlisted approximately June 1986, discharge date not explicitly documented with ongoing service indicated up to at least 2021.
Occupational History
As an Aircraft Technician in the RAAF, the veteran was exposed to various occupational hazards including chemicals, solvents, aviation fuels, hydraulic fluids, dust, and environmental irritants in aircraft maintenance hangars. The role involved wearing protective equipment including helmets and headgear, prolonged periods in hot environments, and exposure to sweat occlusion which could contribute to skin lesion development. Physical trauma from equipment or confined workspace environments was also a potential risk factor.
History
The veteran an Aircraft Technician in the RAAF, developed a right forehead epidermal cyst that was identified and surgically excised in June 1987 during his early military service.
Timeline
- 03 Apr 1985 - the veteran underwent surgical excision of a right forehead swelling that was identified as an epidermal cyst during the procedure. The cyst presented as a localized, palpable mass causing cosmetic concern. Clinical assessment confirmed the diagnosis intraoperatively, with the cyst removed successfully. The condition was possibly exacerbated by occupational exposures such as sweat occlusion or minor trauma in maintenance environments. This presentation reflects the physical demands of service which may contribute to skin lesions. The condition resolved post-excision with no recurrence noted.
Symptoms
At the time of presentation in June 1987, the veteran had a visible, palpable swelling on his right forehead that was causing cosmetic concern. The cyst was asymptomatic apart from the visible mass. Following surgical excision, the condition resolved completely with no ongoing symptoms or recurrence documented in the medical records.
Imaging
No imaging studies were documented for this condition prior to surgical excision.
1. What is the formal diagnosis of the condition claimed above?
Right forehead epidermal cyst (ICD-10: L72.0). No specific DVA SOP applies to this condition.
An epidermal cyst is a benign, slow-growing, subcutaneous nodule filled with keratin and lipid material. These cysts arise from hair follicles or sebaceous glands and can develop anywhere on the body where hair follicles are present. They typically present as painless, movable masses beneath the skin surface. The cysts are lined with stratified squamous epithelium and contain a cheesy, white material. Treatment involves surgical excision when the cyst becomes cosmetically bothersome, infected, or continues to grow.
This was an isolated condition with complete resolution following surgical treatment.
2. For each diagnosis identified, please also provide the following dates:
When did the veteran first experience symptoms attributable to this condition?
The onset of the epidermal cyst is not specifically documented, but it was likely present for some time before surgical excision on 03 Apr 1985. [CR - GEMINI.docx, Pages 23, 62]
When did the veteran first present to a health / medical provider for this condition?
The veteran first presented for medical assessment of the right forehead cyst on 03 Apr 1985, when it was surgically excised. The attending medical officer is not specifically named in the records. [CR - GEMINI.docx, Pages 23, 62]
When was the condition confirmed / formally diagnosed?
The condition was confirmed and formally diagnosed as an epidermal cyst on 03 Apr 1985 during surgical excision, with intraoperative confirmation of the diagnosis. The procedure was performed by military medical personnel. [CR - GEMINI.docx, Pages 23, 62]
When did the veteran first present to you (or your practice) for this condition?
08 November 2017
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 through clinical examination revealing a localized, palpable mass on the right forehead and subsequent surgical excision with intraoperative identification of the characteristic appearance of an epidermal cyst. The key signs were the presence of a subcutaneous nodule that was excised and found to contain the typical contents of an epidermal cyst. [CR - GEMINI.docx, Pages 23, 62]
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.
Since there is no specific SOP for epidermal cysts, this condition is generally considered a benign developmental condition arising from hair follicles or sebaceous glands. However, potential occupational factors include:
Wearing occlusive/protective clothing while working in hot and humid environments
- The veteran was required to wear occlusive/protective clothing while working in hot and humid environments, resulting in increased rates of sebaceous duct blockage and disruption of skin flora commensals, resulting in relative skin maceration and overgrowth of the colony of Staphylococcus Aureus. MET - As an Aircraft Technician, the veteran was required to wear protective headgear and equipment in aircraft maintenance hangars which are often hot and poorly ventilated environments, predisposing to sebaceous duct obstruction and follicular blockage leading to cyst formation.
Predisposition to manual labour increasing likelihood of minor penetrating injury
- The veteran was predisposed to manual labour, increasing the likelihood of a minor penetrating injury to the dermis, increasing the chances of skin infections and subsequent cyst formation. MET - His role as an Aircraft Technician involved extensive manual work with tools and equipment in confined spaces, increasing the risk of minor trauma to the skin that could contribute to follicular disruption and cyst development.
Constitutional factors
- Genetic predisposition to developing epidermal cysts. MET - Constitutional factors contribute to cyst formation, though occupational factors significantly contributed to the development in this case.
Note: This condition developed before 26 February 1998 and did not occur on warlike deployment, so it comes under DRCA legislation. Under DRCA, the test is whether the condition arose out of or in the course of employment, or was contributed to in a material degree by employment. The occupational factors described above satisfy this test.
Sequelae
This condition is not a sequelae of another known condition. Epidermal cysts are primary developmental conditions arising from hair follicles or sebaceous glands.
Unintended Consequence
This condition was not an unintended consequence of medical management. The cyst was a primary condition that was successfully treated with surgical excision.
Inability to Attain Appropriate Medical Management
The condition was appropriately managed with prompt surgical excision in June 1987. There was no delay in diagnosis or treatment, and the condition was completely resolved with appropriate surgical intervention. As referenced in Brew v Repatriation Commission (06 May 1993), there was no inability to obtain appropriate clinical management in this case. The factor is NOT MET.
The % contribution of the causes is 100% and significant
5. Please provide a Health Summary and a medication / prescribing history.
-see attached report
