Bibliographic record
Abstract
This is a report on a 32-year-old man with a history of two previous melanomas with concurrent plaque-type psoriasis. His history dates to 2009, when he was diagnosed with his first melanoma on the right occiput, Clark’s level IV, tumor thickness 1.53 mm, nonulcerated, mitotic index 1/mm2. He subsequently developed nodal recurrence after an initial negative sentinel lymph node biopsy and was treated with complete lymph node dissection. In 2012, he was diagnosed with a second primary melanoma on the right upper chest, Clark’s level IV, tumor thickness 0.9 mm, nonulcerated, mitotic index 3/mm2. Due to worsening longstanding plaque-type psoriasis in 2015 he was placed on apremilast, with a dramatic improvement in his psoriasis within 4 months of starting therapy. Shortly thereafter the patient developed multiple blue-colored skin papules on the scalp near his first melanoma and on the trunk and upper limbs that on biopsy proved to be due to cutaneous metastasis of melanoma. The patient discontinued the apremilast as there was a concern that his tumor had recurred because of the drug. Apremilast is a phosphodiesterase-4 inhibitor that impairs the innate immune system, which mediates cancer immunosurveillance. It is postulated that the use of apremilast in our patient resulted in impaired cancer immunosurveillance and led to a recurrence of his melanoma. Although one cannot exclude the possibility of coincidental recurrence of an already metastatic melanoma (to the lymph nodes), caution should be exercised when considering apremilast in the context of patients with known malignancy, in particular melanoma.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".