“…Indeed, combined whole exome and transcriptome analyses of several ECD tissue samples revealed additional mechanisms leading to ERK activation, including MAP2K1 (encoding MAPK kinase 1 [MAP2K1, alternatively termed MEK1], 32% of patients), NRAS (16%), KRAS mutations (11%), and ARAF (3%) 63,64 . In addition, in‐frame fusions involving several kinases including BRAF , ALK , and NTRK1 were identified in ECD patients without BRAF , MAP2K1 , or N/KRAS point mutations (reviewed in 6, 65, 66). Finally, mutations affecting other signaling pathways such as PIK3CA were also found in 11% of ECD patients 63 .…”