The MITF p.E318K alteration leads to impaired sumoylation and transcriptional dysregulation and has been associated with both a high nevi count (>200) and increased risk of melanoma.6,7 A separate study2 showed an odds ratio of 4.78 for melanoma, while the odds ratio for combined melanoma and RCC among carriers of this alteration was as high as 14.46. This evidence concerns the gene MITF and renal cell carcinoma.