Periocular keratoacanthoma: A clinicopathologic study and diagnostic challenges
Bibliographic record
Abstract
Abstract Purpose: Keratoacanthoma (KA) is a cutaneous neoplasm that presents as a rapidly growing tumor on ultraviolet light-exposed skin. It appears as an exophytic, crater-like lesion filled with keratin. In periocular sites, the eyelids are most often affected. Clinically, diagnosis and distinction from squamous cell carcinoma can be difficult. This study aims to describe the histopathological features and epidemiological characteristics of a large series of KA to highlight its clinical and histopathological features. Patients, Materials, and Methods: Forty-nine cases from the MUHC-McGill University Ocular Pathology and Translational Research Laboratory (1997–2022) were reviewed to determine histopathological and epidemiological traits. Data on age, sex, clinical site, and histopathological features were extracted. Results: Among 49 cases, the average age was 65 years; 60% were male. Sites were upper eyelid 39% ( n = 19), lower eyelid 39% ( n = 19), canthus 8% ( n = 4), eyebrow 2% ( n = 1), and unspecified 12% ( n = 6). Histopathologically, all cases displayed a keratin-filled crater with epidermal acanthosis and hyperkeratosis and parakeratosis. Mild-to-severe atypia, up to carcinoma in situ (CIS), was found in 39% ( n = 19). Mitotic figures were present in cases with atypia. Extensive or focal actinic damage was identified in superficial and deep dermis in all cases. Most cases showed chronic, nongranulomatous inflammation. Conclusions: To the best of our knowledge, this is the largest cohort of eyelid KA. The presence of mild-to-severe atypia and CIS in a minority of cases did not indicate malignant transformation. Attention to patient age and lesion location may contribute to a correct clinical diagnosis in clinical practice and improve diagnostic confidence.
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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 | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.003 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.000 |
| 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".