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His physical examination reveals pallor, alopecia, and gum ulcerations alongside a central venous catheter without surrounding erythema

While classical gene mutations are region-limited, epimutations often occur early in cancer development and have a genome-wide impact, boosting on the one hand the expression of cell survival genes or proto-oncogenes and deactivating on the other hand tumor suppressor genes (TSGs), DNA repair mechanisms as well as cell division brakes, thus leading to carcinogenesis (Schnekenburger and Diederich, 2012

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