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Interestingly, MITF was positive in two cases stained (cases #23 and #33), while other melanocytic markers were negative, including S100, HMB-45, and Melan-A

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Once any of these structural changes occur, the peptide loses its ability to bind melanocortin-1 receptors (MC1R) in melanocytes and melanocortin-4 receptors (MC4R) in the hypothalamus