MAP2K7 and Merkel cell skin cancer: Further, it is well-known that deferring checkpoint inhibitor therapy to later lines of therapy in other immunotherapy-responsive cutaneous malignancies is detrimental to outcomes for the general patient population, even when the alternative first line therapy has significant disease efficacy such as BRAF/MEK inhibitor therapy in melanoma [20] or cytotoxic chemotherapy in Merkel cell carcinoma [2, 21].