“…9 Increased expression of the p53 gene product has been demonstrated under or adjacent to the cornoid lamella of porokeratotic lesions; this unusual overexpression is thought to be associated with the findings of early focal keratinocytes apoptosis in the lesional epidermis, resulting in abnormal terminal differentiation of keratinocytes and dysregulation of loricrin expression, a precursor protein expressed in the final stage of keratinization, cross-linked to form the cornified envelope. 10,11 Interestingly, in the 5 cases (including our patient) of suspected paraneoplastic disseminated superficial porokeratosis reported in literature (Table I), the underlying tumors share a common characteristic, that is, the well-demonstrated pathogenetic role of p53 in carcinogenesis. 3,4 Although p53 protein is frequently overexpressed in human malignancies, we concur with Lee et al 4 that a pathogenic link between malignancy and disseminated superficial porokeratosis might induce the activation, in genetically predisposed subjects, of keratinocyte p53 pathway, …”