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It can be difficult to measure Clark level and Breslow thickness, because the distinction of the onychodermis is not always clear and the underlying phalanx is separated by only a thin dermal collagen layer [6]

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Once it becomes metastatic, it spreads to other parts of the body, complicating treatment and lowering survival rates

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Two genetic loci have been identified on chromosome arms 17p and 2p 99, 174, 187, but about twothirds of cases are caused by mutations in the protein kinase A subunit on 17p24, PRKAR1a gene