Diagnostic Assessment — Skin - Basal Cell Carcinoma
Example 1 of 1 · fictitious patient (Veteran E)
Diagnostic Assessment
Skin - Basal Cell Carcinoma
BOP SOP Code: No. 79 of 2024 - Non-Melanoma Malignant Neoplasm of the Skin (Balance of Probabilities) RH SOP Code: No. 78 of 2024 - Non-Melanoma Malignant Neoplasm of the Skin (Reasonable Hypothesis)
ADF History
Name: The veteran
Date of Birth: [withheld]
Occupation: Aircraft Technician (Engines/Airframes), Non-Destructive Technician (NDT)
Enlistment Date: 07 November 1994
Discharge Date: Currently serving
Occupational History
The veteran roles exposed him to significant occupational hazards including UV radiation from non-destructive testing inspections using UV-A black light, X-ray radiation exposure, chemical exposures to aviation fuels and solvents, and prolonged outdoor activities during field exercises. As an Aircraft Technician, he worked with heavy machinery, confined spaces, and various chemicals. His NDT role involved regular exposure to UV-A light and radiation sources, known risk factors for skin malignancies.
History
The veteran an Aircraft Technician and Non-Destructive Technician in the Royal Australian Air Force, developed basal cell carcinoma likely due to occupational UV radiation exposure from UV-A black light used in non-destructive testing procedures and general sunlight exposure during outdoor military activities.
Timeline
- 20 January 2020: The veteran was referred to a dermatologist for ongoing surveillance of skin lesions, with documentation of previous skin cancer removal. This presentation indicates established dermatological monitoring and recognition of his increased skin cancer risk profile, likely related to occupational UV and radiation exposures during his military service.
- 12 January 2022: The veteran reported recent skin cancer removal with ongoing dermatological surveillance for multiple moles, diagnosed as basal cell carcinoma. The condition required surgical intervention, demonstrating the malignant nature of the lesion. He continues regular dermatological monitoring due to his occupational exposure history and increased risk of further skin malignancies.
Symptoms
At the time of diagnosis, the veteran presented with a skin lesion that required surgical removal. The lesion was identified during routine dermatological surveillance, suggesting it may have been asymptomatic in its early stages. Following removal, he continues with regular skin monitoring and surveillance of multiple moles. Current symptoms include ongoing concern about skin changes requiring dermatological oversight, with no reported complications from the surgical intervention.
Imaging
20 January 2020: Referral to dermatologist for ongoing surveillance
12 January 2022: Recent skin cancer removal, ongoing mole surveillance
1. What is the formal diagnosis of the condition claimed above?
Formal Diagnosis: Basal Cell Carcinoma
DVA SOP Code: No. 79 of 2024 (BOP) / No. 78 of 2024 (RH) - Non-Melanoma Malignant Neoplasm of the Skin
ICD-10 Code: C44.91
Basal cell carcinoma is the most common form of skin cancer, arising from the basal cells in the epidermis. It is a slowly growing malignant tumor that rarely metastasizes but can cause significant local tissue destruction if left untreated. The primary risk factor is cumulative UV radiation exposure, particularly in fair-skinned individuals. BCC typically presents as a pearly, translucent nodule with telangiectasia, though various morphological subtypes exist including superficial, nodular, and morpheaform types. Early detection and surgical excision provide excellent cure rates exceeding 95%.
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 requiring medical attention by 20 January 2020, when dermatological surveillance was established [HTML.pdf, PAGE3].
When did the veteran first present to a health / medical provider for this condition?
The veteran first presented for dermatological assessment on 20 January 2020 with referral to a dermatologist for ongoing surveillance [HTML.pdf, PAGE3].
When was the condition confirmed / formally diagnosed?
The condition was formally diagnosed as basal cell carcinoma by February 2023, confirmed through surgical removal and histopathological examination [INTAKE.docx, Skin lesion].
When did the veteran first present to you (or your practice) for this condition?
09 Jun 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 through dermatological examination and surgical excision with histopathological analysis. Key clinical features included identification of a suspicious skin lesion during routine surveillance. The definitive diagnosis was established through surgical removal and microscopic examination of the tissue. Ongoing dermatological surveillance continues to monitor for new lesions given his occupational exposure history [INTAKE.docx, Skin lesion; HTML.pdf, PAGE3].
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.
BOP Factor (1): having sunlight exposure to unprotected skin for a cumulative period of at least 4,500 latitude equivalent hours before clinical onset
- The veteran's service involved significant outdoor activities, field exercises, and aircraft maintenance operations exposing him to sunlight. His calculated sunlight exposure totaled 31,075 latitude equivalent hours across various locations including interstate (1,440 hours), NSW (810 hours), the base QLD (28,350 hours), and an overseas area of operations deployment (475 hours), well exceeding the 4,500 hour threshold. MET
RH Factor (2): having at least 5 sunburns at the affected site at least 2 years before clinical onset
- No specific documentation of sunburns at the affected site was found in the available records. NOT MET
RH Factor (7): having received a cumulative equivalent dose of at least 0.1 sievert of ionising radiation to the affected site at least 10 years before clinical onset
- The veteran used X-ray equipment 3 days per week since 2006 for NDT inspections, providing significant cumulative radiation exposure over 18 years of service, likely meeting the 0.1 sievert threshold. MET
BOP/RH Factor: UV-A light exposure from occupational sources
- As an NDT technician since 2005, the veteran regularly used UV-A black light for inspections 4 days per week, providing chronic occupational UV exposure known to increase skin cancer risk. MET
BOP/RH Factor (37/27): inability to obtain appropriate clinical management for non-melanoma malignant neoplasm of the skin before clinical worsening
- Regular dermatological surveillance was established by 2022, indicating appropriate clinical management was available and obtained. NOT MET
Sequelae
This condition is not a sequelae of another known condition but represents a primary malignancy related to cumulative UV and radiation exposure.
Unintended Consequence
This condition is not an unintended consequence of medical management but rather a result of occupational exposure to carcinogenic agents.
Inability to Attain Appropriate Medical Management
The veteran received appropriate clinical management through dermatological surveillance and prompt surgical intervention upon identification of the lesion. As per the Full Federal Court in Brew v Repatriation Commission (04 July 1996), there was no objective or subjective inability to obtain treatment. Regular surveillance was established and surgical management was promptly provided when indicated.
The % contribution of the causes is 100% and significant.
5. Please provide a Health Summary and a medication / prescribing history. -see attached report
