Our findings indicate that, in the appropriate clinical setting, a smaller orificial size, although predictive of a KA, in itself is not sufficient for a definitive diagnosis. Given that a major limitation is that this is a function of age of the lesion as orificial size depends on the evolution stage of the neoplasm with the largest diameter often evident in lesions at early stages of regression, for now correlation with histopathologic features such as presence of an epithelial lip, sharp demarcation of tumor from stroma, and fibrosis (present in >95% of cases of KAs) is required.