Asymptomatic erythematous atrophic plaque in a kidney transplant recipient
Bibliographic record
Abstract
A 76-year-old Caucasian male presented to the dermatology clinic for an annual full-body skin exam. The patient had a kidney transplant in 2010 for end-stage renal disease secondary to glomerulonephritis. Induction therapy included methylprednisolone and basiliximab. At presentation, his immunosuppressive regimen included tacrolimus, prednisone, and leflunomide. As the donor kidney was positive for polyomavirus infection, leflunomide was selected for treatment as a combination immunosuppressive and antiviral agent. The patient had no history of transplant rejection. The patient was referred in 2011, one year posttransplant, for routine skin examinations. The patient had no history of skin cancer prior to immunosuppression. The patient did not receive a dermatology consultation pretransplant for risk assessment. However, since his transplant and referral to the dermatology clinic, multiple histopathologically confirmed skin cancers, including basal cell carcinoma and Bowen’s disease, were diagnosed. Each cancer was excised with negative margins and no evidence of recurrence at follow-up visits. He was also treated for multiple precancerous skin lesions. At his most recent routine dermatology visit, a suspicious lesion was identified. Physical examination revealed a well-demarcated, double-rimmed plaque with a thinned center measuring 1.2 cm by 0.8 cm on the left lateral lower leg (Figure 1, Figure 2). The patient did not describe the lesion as painful, pruritic, or evolving. He did not report a history of repetitive sun exposure or burns to the affected area.FIGURE 2Low (A) and high power (B) microscopy of the lesion. The coronoid lamella is best visualized with high power microscopy (B). It is characterized by a column of parakeratosis overlying the epidermis. This image represents an example of the lesion and is not from the patient described in the caseView Large Image Figure ViewerDownload Hi-res image Download (PPT) 1What is your diagnosis of the lesion in Figures 1 and 2?aBasal cell carcinomabSeborrheic keratosiscPorokeratosisdActinic keratosiseVerruca vulgaris2What is classically seen on dermoscopic visualization of this lesion? aBranching vessels and blue-gray ovoid nestsbUlceration with a central mass of keratincInterruption of skin lines and prominent hemorrhagesdWell-defined, raised peripheral annular structureeLinear sulci with keratin plugging3What is the most concerning natural history of this lesion if it remains untreated?aMalignant transformationbPersistent lesion without evolutioncBenign enlargement of lesiondSpontaneous regressioneUlceration and spontaneous bleeding4What is the typical histopathological presentation of this type of lesion?aPresence of a narrow column of parakeratotic cellsbPigmented hyperkeratosis and acanthosiscAreas of increased melanogenesisdIntracellular edema and lymphoplasmacytic infiltrate
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
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 teacher head, 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".