Malignant melanoma of the skin - PUVA therapy Factor
RMA definition
PUVA is defined by the RMA as "photochemotherapy with oral methoxsalen (psoralen) and ultraviolet A radiation".
Description
Psoralen (which may be referred to as methoxypsoralen, methoxsalen or oxsoralen) is a photosensitiser which may be in capsule form or as a lotion for topical application. It has been used to treat many cases of vitiligo but is also used to treat severe, recalcitrant or disabling psoriasis. Oxsoralen alone has no effect but must be followed by UV exposure (either sunlight or artificial source) and only the skin that is exposed is altered. Following ingestion, the skin becomes photosensitive in about 1 hour. Peaking 2 hours after intake, this sensitivity vanishes in 8 hours. The exposure time and intensity of UV light must be measured and controlled.
Note: The RMA definition of PUVA treatment limits this to the oral taking of psoralen with long-wave UVA. It does not include topical application of psoralen.
Establishing a history of PUVA therapy
If a person had undergone PUVA treatment, this would have been carried out by a specialist. Such medical treatment would normally be recorded in doctors' notes and/or hospital records. However, these records may have been destroyed or can no longer be obtained. Therefore, if there is a reliable history of PUVA treatment at a particular time, this generally will be accepted, unless there is contradictory evidence. Seek medical advice if it is unclear whether the claimed PUVA treatment is medically feasible.
Last reviewed for CCPS 26 September 2007.
Investigative Documents
| Type | Title | PDF Format | Word Format |
|---|---|---|---|
| Medical Report | PUVA Therapy |
Preliminary questions [31579]
12960 there is some evidence that PUVA treatment may be a factor in the development of the condition under consideration.
12852 the veteran underwent PUVA therapy at some time.
31580 the veteran received at least 250 PUVA treatments at some time.
12854 the veteran's PUVA therapy, where at least 250 PUVA treatments were administered, was materially contributed to by treatment of an illness or injury which is identifiable.
31581 the identified illness or injury made a material contribution to the veteran's PUVA therapy, where at least 250 PUVA treatments were administered, before the clinical onset of the condition under consideration.
31582 where the identified illness or injury made a material contribution to the veteran's PUVA therapy, and at least 250 PUVA treatments were administered before the clinical onset of the condition under consideration, the first of those treatments commenced at least 15 years before the clinical onset of the condition under consideration.
31583 the veteran has established the causal connection between PUVA therapy and VEA service for the clinical onset of malignant melanoma of the skin.
31584 the veteran has established the causal connection between PUVA therapy and operational service for the clinical onset of malignant melanoma of the skin.
or
31585 the veteran has established the causal connection between PUVA therapy and eligible service for the clinical onset of malignant melanoma of the skin.
Clinical onset and operational service [31584]
12863 the identified illness or injury, which made a material contribution to the veteran's PUVA therapy where at least 250 PUVA treatments were administered before the clinical onset of the condition under consideration, is causally related to operational service.
Clinical onset and eligible service [31585]
12864 the identified illness or injury, which made a material contribution to the veteran's PUVA therapy where at least 250 PUVA treatments were administered before the clinical onset of the condition under consideration, is causally related to eligible service.