Studies comparing primary nonmetastatic cSCC, primary metastatic cSCC, and their corresponding lymphatic metastases demonstrate podoplanin, Twist, Zeb 1, vimentin, and beta-catenin overexpression in metastatic cSCC, with Twist ectopic expression inducing Zeb1, vimentin, and podoplanin expression and also E-cadherin delocalization, resulting in scattered migration pattern in vitro [33]. The gene discussed is TWIST1; the disease is skin squamous cell carcinoma.