Bonkhoff et al. in 1999 revealed for the first time an increase in ESR1 expression correlating with metastatic PC lesions including lymph nodes [53] and, years later, demonstrated that progressing PC bypasses the androgenic cascade in favor of the re-emergence of the alternative ESR1 steroidal pathway [51], which resembled our findings. Here, ESR1 is linked to pachyonychia congenita.