Developments in NGS technology have enabled successful discovery of disease-associated somatic variation within affected tissue.1,2 It is now recognized that vascular malformations and overgrowth demonstrate some shared genetic variation with cancer, with the phosphoinositide 3-kinase (PI3K)-AKT growth signaling pathway commonly dysregulated in both sets of disease.3–5. The gene discussed is PIK3CA; the disease is cancer.