Despite the high prevalence of MCPyV, the incidence of MCC is very low (~3 per 1,000,000).2,3 However, evidence of integrated MCPyV DNA is high (66–80%) and pathognomonic for the presence of MCC.19,23 The cap-dependent translation regulator (4E-BP1) is activated by the small tumor antigen (ST). This evidence concerns the gene EIF4EBP1 and Merkel cell skin cancer.