Initially these reported no abnormalities, but approximately nine years from his initial PC presentation, the clinical reports of the liquid biopsies began to demonstrate multiple molecular abnormalities at rising variant allele fractions (VAFs), including TP53 p.G245D, BRCA1 p.N1521fs, MYC amplification and FGFR3ex18-TACC3ex12 fusion (Figs. 1A, B). This evidence concerns the gene BRCA1 and pachyonychia congenita.