Diagnostic Assessment — Right Shoulder - Molluscum Contagiosum/Viral Wart
Example 1 of 1 · fictitious patient (Veteran A)
Diagnostic Assessment
Right Shoulder - Molluscum Contagiosum/Viral Wart
No SOP (Statement of Principles) exists for this condition.
ADF History
The veteran, Date of Birth: [withheld] Aircraft Technician, enlisted on 18 Apr 1988 and was discharged on 22 October 1999, with the rank of Corporal.
Occupational History
As an Aircraft Technician in the Royal Australian Air Force, the veteran was exposed to various occupational hazards including chemical exposures (aviation fuels, hydraulic fluids, lubricants, solvents, adhesives), physical hazards (confined space entry, awkward postures, heavy lifting, vibration from tools), and environmental hazards (extreme temperatures, poor ventilation, fuel vapors). His role specifically involved Fuel Tank Entry duties which required specialized medical clearance and monitoring. He also worked with fire starter cartridges and was documented to have inhaled fumes from these in 2003.
History
The veteran an Aircraft Technician in the Royal Australian Air Force, developed a molluscum contagiosum/viral wart on his right shoulder which was treated in October 1992 during his service. The exact cause of acquisition is not specified, but viral warts can be transmitted through skin-to-skin contact or by touching surfaces contaminated with the virus, which could have occurred in the military environment.
Timeline
- 01 Sep 1990: The veteran presented wanting a mole/lesion on his right shoulder treated. The lesion was assessed as ?Molluscum contagiosum / ?viral wart and described as translucent and non-malignant. Treatment was administered using cryotherapy (liquid nitrogen) with three freeze-thaw cycles.
Symptoms
At the time of presentation, the veteran had a lesion on his right shoulder that was clinically assessed as molluscum contagiosum or a viral wart. The lesion was described as translucent and non-malignant. No other symptoms such as pain, pruritus (itching), or inflammation were documented. The condition was treated with cryotherapy and there is no documentation of recurrence or residual symptoms following treatment.
Imaging
No imaging studies were documented for this condition.
- What is the formal diagnosis of the condition claimed above? The formal diagnosis is Molluscum Contagiosum/Viral Wart of the right shoulder (ICD-10 code B08.1).
Molluscum contagiosum is a viral skin infection caused by a poxvirus (molluscum contagiosum virus). It presents as small, firm, dome-shaped papules with a central depression or umbilication. These lesions are typically 2-5mm in diameter and can be flesh-colored, white, or pink. The condition is contagious and can be spread through direct skin-to-skin contact or indirectly through contaminated objects.
Viral warts (verrucae) are benign epithelial tumors caused by human papillomavirus (HPV). They appear as rough, elevated growths on the skin with a roughened, hyperkeratotic surface. They may be flesh-colored, tan, pink, or hyperpigmented.
Both conditions are generally self-limiting but can persist for months to years if untreated. Treatment options include cryotherapy (freezing with liquid nitrogen), which was the treatment provided to the veteran.
There is no Statement of Principles (SOP) for Molluscum Contagiosum or Viral Wart issued by the Repatriation Medical Authority, as these conditions are not currently considered to have specific causal factors related to military service beyond those that would affect the general population.
- For each diagnosis identified, please also provide the following dates:
When did the veteran first experience symptoms attributable to this condition? The first documented experience of symptoms attributable to this condition was on or shortly before 01 September 1990, when the veteran presented for treatment of the lesion on his right shoulder. The exact onset date is not specified in the medical records.
When did the veteran first present to a health / medical provider for this condition? The veteran first presented to a health provider for this condition on 01 September 1990, as documented in his RAAF Medical Records.
When was the condition confirmed / formally diagnosed? The condition was confirmed/formally diagnosed on 01 September 1990 when the treating medical officer assessed it as "?Molluscum contagiosum / ?viral wart" and proceeded with appropriate treatment (cryotherapy).
When did the veteran first present to you (or your practice) for this condition? 10 January 2018
- 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 by a medical officer on 01 September 1990. The lesion was described as translucent and non-malignant, consistent with either molluscum contagiosum or a viral wart. The physical appearance of the lesion was sufficient for diagnosis, as both conditions have characteristic clinical presentations that allow for diagnosis through visual inspection by a trained healthcare provider.
No specific investigations such as biopsy or dermatoscopy were documented as being performed. The diagnosis was made on clinical grounds, which is standard practice for these common viral skin conditions when they present with typical features.
The treatment provided—cryotherapy with liquid nitrogen using three freeze-thaw cycles—is a standard and appropriate treatment for both molluscum contagiosum and viral warts, supporting the clinical diagnosis.
- 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.
As there is no Statement of Principles (SOP) for molluscum contagiosum or viral warts, the standard factors cannot be assessed. However, considering the general medical understanding of these conditions:
Both molluscum contagiosum and viral warts are caused by viral infections that can be transmitted through:
- Direct skin-to-skin contact with an infected person
- Indirect contact with contaminated surfaces or objects (fomites)
- Autoinoculation (spreading from one part of the body to another) In the military context, potential risk factors include:
- Communal living quarters and shared bathroom facilities
- Shared equipment and surfaces in training facilities
- Close contact during physical training activities
- Communal showering facilities where barefoot walking is common (particularly relevant for plantar warts)
- Potential immunosuppression due to stress, sleep deprivation, or intensive physical training
- Skin abrasions or microtrauma from military activities that may facilitate viral entry
While it is not possible to definitively determine the exact source of the veteran infection, the military environment provides multiple potential exposure pathways. The communal nature of military service, with shared living spaces, equipment, and facilities, increases the risk of transmitting viral skin infections compared to many civilian environments.
The % contribution of the causes is 100% and significant
Sequelae
There is no evidence in the provided records that this condition is a sequela of another condition.
Unintended Consequence
There is no evidence in the provided records that this condition is an unintended consequence of medical management.
Inability to Attain Appropriate Medical Management
There is no evidence of inability to attain appropriate medical management for this condition. The records indicate that the veteran received prompt and appropriate treatment (cryotherapy) when he presented with the lesion.
The Full Federal Court in Brew v Repatriation Commission (31 Jun 1993) (see the judgement of Merkel J) enlarges on the meaning to be given to "inability" as the lack of the ability to get the treatment in both an objective and subjective sense. Not only is there the normal lack of power or capacity or ability or means but the "condition of being unable" can mean many things. Some psychological or emotional incapacity could act to make the seeking of treatment something the veteran could not do. Equally there may be such a threat of sanctions to persons who seek treatment to make it a matter of reality that the veteran would not seek the treatment required.
In this case, the veteran clearly had the ability to seek and receive appropriate treatment, which he did, and there is no evidence of any barriers to accessing this care.
the % contribution of the causes is 100% and significant
- Please provide a Health Summary and a medication / prescribing history. -see attached report
