In one set of studies done in both Africa and the United States, evidence of HPV infection was found in most CSCC tumor samples.13, 14, 15, 16, 17, 18, 19, 20 In contrast, another set of studies from Africa as well as from other regions of the world such as the United States, Germany, Brazil, and Mexico has found no evidence of HPV in CSCC.10, 21, 22, 23, 24 In addition, prognostic tumor biomarkers like cyclin D, p16, estimated glomerular filtration rate (EGFR), and p53 have been described in CSCC in the United States, but these are not well studied in CSCC in Africa.25, 26, 27. This evidence concerns the gene EGFR and neoplasm.