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A punch biopsy may be taken with histopathological findings of SPP such as: Mild acanthosis with parakeratosis Spongiosis Superficial perivascular lymphohistiocytic infiltrate Plasma collection over basket weave keratin associated with confluent linear parakeratosis is an additional characteristic finding

This would be problematic in a case where the ACO's financial performance in the BY corresponding to the performance year that was financially reconciled is atypically high because it would upwardly bias the prediction of the ACO's financial performance for a given performance year within the current agreement period