Solar Keratosis M011
Current RMA Instruments:
| Reasonable Hypothesis SOP [1] | 73 of 2012 |
| Balance of Probabilities SOP [2] | 74 of 2012 |
Changes from Previous Instruments:
SOP Bulletin 162 [3]
ICD Coding:
- ICD-9-CM: 702.0
- ICD-10-AM: L57.0
Brief description:
Solar keratoses are scaly or crusty spots that occur on sun-exposed areas of skin. They are potentially pre-cancerous and may turn into squamous cell carcinomas.
Confirming the diagnosis:
The diagnosis can be made on clinical grounds, so a report from a treating medical practitioner is sufficient to confirm the diagnosis. Histology reports may be available in some cases.
The relevant medical specialist is a dermatologist.
Additional diagnoses covered by these SOPs
- Actinic keratosis
Conditions not covered by these SOPs
- Basal cell carcinoma (skin)* (Non melanotic malignant neoplasm of the skin)
- Bowen’s disease* (Non melanotic malignant neoplasm of the skin)
- Chronic solar skin damage other than solar keratosis#
- Hutchinson’s melanotic freckle#
- Malignant melanoma of the skin*
- Seborrhoeic keratosis*
- Solar elastosis#
- Squamous cell carcinoma (skin)* (Non melanotic malignant neoplasm of the skin)
*another SOP applies - the SOP has the same name unless otherwise specified
# non-SOP condition
Clinical onset
The clinical onset will be when a lesion, subsequently confirmed to be a solar keratosis by a medical practitioner, is first noted by an individual. Age of onset varies with sun-exposure and skin type. Onset may be early in adult life in some cases, but more typically it occurs in middle to later life.
Clinical worsening
The only SOP worsening factor is for inability to obtain appropriate clinical management. Appropriate clinical management involves timely treatment and monitoring of the condition and advice on sun-protection measures. A range of medical and surgical treatment options are available. The natural history of the condition is for multiple lesions to occur and to continue to develop over time, typically becoming more numerous with time.
Further comments on diagnosis
This SOP covers solar or actinic keratosis but not other chronic solar skin damage (solar elastosis) and not non-melanotic malignant skin neoplasms. However, a claim for non-malignant chronic solar skin damage will generally be best answered using the solar keratosis SOP. Other forms of chronic solar skin damage have little if any clinical significance and generally do not require treatment.
Factors in CCPS as at 20 April 2005 (M011)
- Log in [4] to post comments
Important Information
- The investigation questions displayed here are based on factors that were current at the time that they were incorporated into the CCPS application.
- There may have been new instruments for this SOP condition issued after they were added to the CCPS application.
- Please ensure that you refer to and use the latest instruments for this SOP condition (solar keratosis).
Current Statements of Principles
- Please refer to the Repatriation Medical Authority (RMA) Website to confirm the most recent instruments for this SOP condition (solar keratosis).
- The solar keratosis Instruments at the RMA Website (Page 'S' [5]) will contain the latest SOP Factors.
The following solar keratosis factors were last reviewed for CCPS on 20 April 2005.
Cutaneous contact with bipyridyl compounds associated with paraquat manufacture
Solar keratosis - Cutaneous contact with bipyridyl compounds associated with paraquat manufacture Factor
The SOP refers to cutaneous contact with “bipyridyl compounds associated with paraquat manufacture”. The RMA has defined paraquat as meaning “a dipyridilium compound whose dichloride and dimethylsulphate salts are used as contact herbicides”.
General information
The chemical name of the bipyridine used in paraquat manufacture is 4,4’-bipyridinium. A bipyridyl compound therefore must be based on 4,4’-bipyridinium and not any other form such as 2,2’-bipyridinium (synonym 2,2’-dipyridyl). Diquat, a herbicide, is based on 2,2'-dipyridylium and is not an example that meets the definition.
Gramoxone is the commercial name for the paraquat herbicide used by the Australian Forces in Vietnam.
Paraquat has been available commercially since 1961. Paraquat is highly toxic herbicide. Between 1975 and 1977 a stenching agent, an emetic to induce vomiting, and a blue dye were added, to nearly all products, to prevent accidental poisoning. Personal protection would require overalls, face shield, goggles, mask or respirator, elbow-length impervious gloves, splash apron and rubber boots. Contact with the skin can cause inflammation, blistering and white spots on the nails. Treatment would usually require immediate washing with water then soap and water.
Last reviewed for CCPS 20 April 2005.
Investigative Documents
| Type | Title | PDF Format | Word Format |
|---|---|---|---|
| Claimant Report | Cutaneous Contact with Paraquat |  CR9240.pdf [6] |  CR9240.docx [7] |
reliminary questions [34691]
34692 there is some evidence that cutaneous contact with bipyridyl compounds associated with paraquat manufacture may be a factor in the development of the condition under consideration.
34693 the veteran has had cutaneous contact of side and site of the body with bipyridyl compounds associated with paraquat manufacture at some time.
34694 the veteran had cutaneous contact of side and site of the body with bipyridyl compounds associated with paraquat manufacture on more days than not for a cumulative period of at least five years.
34695 the veteran had cutaneous contact of side and site of the body with bipyridyl compounds associated with paraquat manufacture on more days than not for a cumulative period of at least five years before the clinical onset of the condition under consideration.
34696 the veteran has established the causal connection between cutaneous contact with bipyridyl compounds associated with paraquat manufacture and operational service for the clinical onset of non-melanotic malignant neoplasm of the skin.
Clinical onset and operational service [34696]
34697 operational service made a material contribution to the veteran having cutaneous contact of side and site of the body with bipyridyl compounds associated with paraquat manufacture on more days than not for a cumulative period of at least five years before the clinical onset of the condition under consideration.
Having been a prisoner of war of the Japanese
Solar keratosis - Having been a prisoner of war of the Japanese Factor
Prisoners of war are identified on the client data base. The veteran's statement of service will also record the fact that he or she was a prisoner of war.
Commission has defined a prisoner of war as a veteran who has been confined in a camp, building, prison or other restrictive area as a prisoner of the enemy, even if the confinement was for only a few hours.
Last reviewed for CCPS 20 April 2005.
Clinical onset and operational service [10447]
30261 there is some evidence that having been a prisoner of war of Japan may be a factor in the development of the condition under consideration.
2352 the veteran was a prisoner of war of Japan at some time.
27396 the veteran was a prisoner of war of Japan before the clinical onset of the condition under consideration.
Immunosuppressive drugs
Solar keratosis - Immunosuppressive drugs Factor
Immunosuppressive drugs are defined by the RMA as meaning "drugs or agents administered for the purpose of suppressing immune responses, but does not include inhaled or topical steroids". In the SOPs for cardiomyopathy and solar keratosis, the method of administration is specified as "orally, intravenously or intramuscularly" whereas the SOP for soft tissue sarcoma also includes administration rectally or subcutaneously.
Immunosuppressive drugs can be given as treatment for organ transplant, autoimmune diseases (such as rheumatoid arthritis, SLE, some kidney diseases (such as nephrotic syndrome), vasculitis and some cancers.
Corticosteroids are the most commonly prescribed immunosuppressive drugs. Other drugs include Cyclophosphamide, Azathioprine, Methotrexate and Cyclosporin. Seek medical or pharmaceutical advice for details as to whether a particular drug is immunosuppressive.
Last reviewed for CCPS 20 April 2005.
Preliminary questions [12811]
12967 there is some evidence that treatment with immunosuppressive drugs may be a factor in the development of the condition under consideration.
34536 the veteran has been treated with immunosuppressive drugs at some time.
13976 the veteran has been treated with immunosuppressive drugs for a continuous period of twelve weeks at some time.
13977 the treatment with immunosuppressive drugs for a continuous period of twelve weeks was materially contributed to by treatment of an illness or injury which is identifiable.
12824 the veteran has established the causal connection between the identified illness or injury for which treatment with immunosuppressive drugs was given and VEA service for the clinical onset of the condition under consideration.
12825 the veteran has established the causal connection between the identified illness or injury for which treatment with immunosuppressive drugs was given and operational service for the clinical onset of the condition under consideration.
or
12826 the veteran has established the causal connection between the identified illness or injury for which treatment with immunosuppressive drugs was given and eligible service for the clinical onset of the condition under consideration.
Clinical onset and operational service [12825]
34503 the identified illness or injury made a material contribution to the veteran being treated with immunosuppressive drugs for a continuous period of twelve weeks before the clinical onset of the condition under consideration.
34505 the identified illness or injury which made a material contribution to the veteran being treated with immunosuppressive drugs for a continuous period of twelve weeks is causally related to operational service.
Clinical onset and eligible service [12826]
34500 the veteran has been treated with immunosuppressive drugs for a continuous period of twenty-four weeks at some time.
34501 the identified illness or injury made a material contribution to the veteran being treated with immunosuppressive drugs for a continuous period of twenty-four weeks.
34502 the identified illness or injury made a material contribution to the veteran being treated with immunosuppressive drugs for a continuous period of twenty-four weeks before the clinical onset of the condition under consideration.
34504 the identified illness or injury which made a material contribution to the veteran being treated with immunosuppressive drugs for a continuous period of twenty-four weeks is causally related to eligible service.
Inability to obtain appropriate clinical management for solar keratosis
Solar keratosis - Inability to obtain appropriate clinical management for solar keratosis Factor
Appropriate clinical management of solar keratosis includes avoidance of sun exposure (ranging from the wearing of protective clothing and the use of solar skin protection creams through to the avoidance of outdoor activities during daylight), removal of lesions by use of carbon dioxide snow or slush, liquid nitrogen, electro-cautery, diathermy, or curettage, and obtaining histology reports regarding suspicious lesions.
Last reviewed for CCPS 20 April 2005.
Investigative Documents
|
Type |
Title |
PDF Format |
Word Format |
|---|---|---|---|
| Medical Report | Inability to Obtain Appropriate Clinical Management |
GQACM.pdf [8] |
 GQACM.docx [9] |
Preliminary questions [32601]
11109 the condition under consideration has been accepted on the basis of inability to obtain appropriate clinical management for the condition under consideration.
7066 there is some evidence that an inability to obtain appropriate clinical management for the condition under consideration may be a factor in the worsening of the condition under consideration.
7334 the clinical onset of the condition under consideration occurred after the end of the veteran's last period of VEA service.
7335 the condition under consideration permanently worsened.
7378 the veteran was unable to obtain appropriate clinical management for the condition under consideration at some time.
7379 the inability to obtain appropriate clinical management for the condition under consideration contributed to the clinical worsening of the condition under consideration.
11234 the veteran has established the causal connection between the inability to obtain appropriate clinical management for the condition under consideration and VEA service for the clinical worsening of the condition under consideration.
11235 the veteran has established the causal connection between the inability to obtain appropriate clinical management for the condition under consideration and operational service for the clinical worsening of the condition under consideration.
or
11236 the veteran has established the causal connection between the inability to obtain appropriate clinical management for the condition under consideration and eligible service for the clinical worsening of the condition under consideration.
Clinical worsening and operational service [11235]
7384 the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, during operational service.
21084 the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, during operational service, as a causal result of operational service.
7387 the veteran's inability to obtain appropriate clinical management for the condition under consideration during operational service was due to the veteran's serious default, wilful act or serious breach of discipline.
or
7389 the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, because of an illness or injury which is identifiable.
7390 the identified illness or injury which prevented the veteran from obtaining appropriate clinical management for the condition under consideration is causally related to operational service.
7392 the clinical onset of the condition under consideration occurred prior to that part of operational service to which the identified illness or injury that prevented the veteran from obtaining appropriate clinical management for the condition under consideration is causally related.<hot
Clinical worsening and eligible service [11236]
7385 the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, during eligible service.
7386 the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, during eligible service, as a causal result of eligible service.<ho
7388 the veteran's inability to obtain appropriate clinical management for the condition under consideration during eligible service was due to the veteran's serious default, wilful act or serious breach of discipline.
or
7389 the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, because of an illness or injury which is identifiable.<hotword "zzz
7391 the identified illness or injury which prevented the veteran from obtaining appropriate clinical management for the condition under consideration is causally related to eligible service.
7393 the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the identified illness or injury that prevented the veteran from obtaining appropriate clinical management for the condition under consideration is causally related.
Increased risk due to solar exposure on service
Solar keratosis - Increased risk due to solar exposure on service Factor
Only investigate this factor if the claim cannot succeed under any other SOP factor.
All people living in Australia experience a significant level of harmful solar radiation which can cause a number of conditions. The risk of damage due to solar exposure may have been increased significantly by conditions experienced during service: Physical requirements, duties, and workplace hazards of specific military occupations.
Last reviewed for CCPS 20 April 2005.
Preliminary questions [21702]
39410 there is some evidence that increased risk due to solar exposure on service may be a factor in the development of the condition under consideration.
21703 the veteran has established the causal connection between the increased risk due to solar exposure on service and VEA service for the clinical onset of the condition under consideration.
21704 the veteran has established the causal connection between the increased risk due to solar exposure on service and operational service for the clinical onset of the condition under consideration.
or
21705 the veteran has established the causal connection between the increased risk due to solar exposure on service and eligible service for the clinical onset of the condition under consideration.
Clinical onset and operational service [21704]
10158 the veteran had an increased risk of solar UV damage from ultraviolet radiation exposure to side and site of the body due to operational service of at least 10 percent before the clinical onset of the condition under consideration.
10160 the veteran's increased risk of solar UV damage from ultraviolet radiation exposure to side and site of the body due to operational service of at least 10 percent before the clinical onset of the condition under consideration was due to the veteran's serious default, wilful act or serious breach of discipline.
Clinical onset and eligible service [21705]
10159 the veteran had an increased risk of solar UV damage from ultraviolet radiation exposure to side and site of the body due to eligible service of at least 20 percent before the clinical onset of the condition under consideration.
10161 the veteran's increased risk of solar UV damage from ultraviolet radiation exposure to side and site of the body due to eligible service of at least 20 percent before the clinical onset of the condition under consideration was due to the veteran's serious default, wilful act or serious breach of discipline.
Prolonged sunlight exposure
Solar keratosis - Prolonged sunlight exposure Factor
Sunlight exposure as a factor requires only a total dose (in hours) of sun exposure to unprotected skin at the affected site. It will be necessary to consider and determine different body sites separately to account for different exposure at the different sites. The factor requires sunlight exposure for a specified number of hours while in a tropical area or equivalent sunlight exposure in other latitude zones. The RMA has specified a weighting factor to be applied depending on the latitude zone where sunlight exposure took place.
Last reviewed for CCPS 20 April 2005.
Preliminary questions [34474]
34475 the veteran has established the causal connection between sunlight exposure to unprotected skin and VEA service for the clinical onset of the condition under consideration.
34476 the veteran has established the causal connection between sunlight exposure to unprotected skin and operational service for the clinical onset of the condition under consideration.
or
34477 the veteran has established the causal connection between sunlight exposure to unprotected skin and eligible service for the clinical onset of the condition under consideration.
Clinical onset and operational service [34476]
34478 the veteran had sunlight exposure to unprotected skin of side and site of the body for at least 2250 hours, normalised for latitude, at some time.
34480 the veteran had sunlight exposure to unprotected skin of side and site of the body for at least 2250 hours, normalised for latitude, before the clinical onset of the condition under consideration.
34482 operational service made a material contribution to the veteran's sunlight exposure to unprotected skin of side and site of the body for at least 2250 hours, normalised for latitude, before the clinical onset of the condition under consideration.
Clinical onset and eligible service [34477]
34479 the veteran had sunlight exposure to unprotected skin of side and site of the body for at least 4500 hours, normalised for latitude, at some time.
34481 the veteran had sunlight exposure to unprotected skin of side and site of the body for at least 4500 hours, normalised for latitude, before the clinical onset of the condition under consideration.
34483 eligible service made a material contribution to the veteran's sunlight exposure to unprotected skin of side and site of the body for at least 4500 hours, normalised for latitude, before the clinical onset of the condition under consideration.
PUVA treatment
Solar keratosis - PUVA treatment Factor
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 20 April 2005.
Investigative Documents
|
Type |
Title |
PDF Format |
Word Format |
|---|---|---|---|
| Medical Report | PUVA Therapy |
MR9266.pdf [10] |
MR9266.docx [11] |
Preliminary questions [12814]
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.
12853 the veteran underwent PUVA therapy to side and site of the body at some time.
34506 the veteran underwent PUVA therapy to side and site of the body, where at least 25 PUVA treatments were administered, at some time.
34507 the veteran's PUVA therapy to side and site of the body, where at least 25 PUVA treatments were administered, was materially contributed to by treatment of an illness or injury which is identifiable.
12855 the veteran has established the causal connection between PUVA treatment and VEA service for the clinical onset of the condition under consideration.
12857 the veteran has established the causal connection between PUVA treatment and operational service for the clinical onset of the condition under consideration.
or
12858 the veteran has established the causal connection between PUVA treatment and eligible service for the clinical onset of the condition under consideration.
Clinical onset and operational service [12857]
12859 the identified illness or injury made a material contribution to the veteran's PUVA therapy to side and site of the body, where at least 25 PUVA treatments were administered, before the clinical onset of the condition under consideration.
12861 where the identified illness or injury made a material contribution to the veteran's PUVA therapy to side and site of the body, where at least 25 PUVA treatments were administered, before the clinical onset of the condition under consideration, the first of those treatments commenced at least five years before the clinical onset of the condition under consideration.
34508 the identified illness or injury, which made a material contribution to the veteran's PUVA therapy to side and site of the body, where at least 25 PUVA treatments were administered before the clinical onset of the condition under consideration, is causally related to operational service.
Clinical onset and eligible service [12858]
12860 the veteran has undergone PUVA therapy to side and site of the body, where at least 50 PUVA treatments were administered, at some time.
12845 the identified illness or injury made a material contribution to the veteran's PUVA therapy to side and site of the body, where at least 50 PUVA treatments were administered.
12856 the identified illness or injury made a material contribution to the veteran's PUVA therapy to side and site of the body, where at least 50 PUVA treatments were administered, before the clinical onset of the condition under consideration.
12862 where the identified illness or injury made a material contribution to the veteran's PUVA therapy to side and site of the body, where at least 50 PUVA treatments were administered, before the clinical onset of the condition under consideration, the first of those treatments commenced at least five years before the clinical onset of the condition under consideration.
34509 the identified illness or injury, which made a material contribution to the veteran's PUVA therapy to side and site of the body, where at least 50 PUVA treatments were administered before the clinical onset of the condition under consideration, is causally related to eligible service.
Links
[1] http://www.rma.gov.au/assets/SOP/2012/073.pdf
[2] http://www.rma.gov.au/assets/SOP/2012/074.pdf
[3] https://clik.dva.gov.au/system/files/media/Bull162_1.pdf
[4] https://clik.dva.gov.au/user/login?destination=comment/reply/64132%23comment-form
[5] http://www.rma.gov.au/SOP/alpha_ind/s.htm
[6] http://awsp76.main.dva/system/files/media/CR9240.pdf
[7] http://awsp76.main.dva/system/files/media/CR9240.docx
[8] https://clik.dva.gov.au/system/files/media/GQACM_4.pdf
[9] https://clik.dva.gov.au/system/files/media/GQACM_4.docx
[10] https://clik.dva.gov.au/system/files/media/MR9266_0.pdf
[11] https://clik.dva.gov.au/system/files/media/MR9266.docx