In response: In a recent publication in the American Journal of Dermatopathology,1 the authors present a case of Merkel cell carcinoma as “unique,” being negative for both cytokeratin 20 (CK20) and CK7 and affirming that the CK20 negative Merkel cell carcinoma cases “always” are positive CK7. The bibliography that the authors cite includes a series of 7 cases of Merkel cell carcinoma negative for cytokeratin 20 and positive for cytokeratin 7,2 an immunohistochemical pattern that had not been previously published. Pilloni and collaborators in 20093 published an additional case with this atypical profile. The double negativity for CK 20 and CK 7 has been previously reported in different case series as the one of Jensen and collaborators in the year 2000 (3 of 26 cases were doubly negative for CK20 and CK7, 6 additional cases were positive for CK20 and CK7, and no case was CK 20− and CK 7+), Chu et al (2 of 9 cases had double negativity CK20 and CK7, the rest of cases were CK20 +/CK7−, and none was CK 20− and CCK 7+), and Miner 2015 (9 of the 13 cases had double negativity for CK20 and CK7, and only 2 cases were CK20−/CK7+). Therefore, the expression of CK7 is independent of the expression of CK 20 in Merkel cell carcinoma and it is possible to find all the scenarios: CK20 +/CK7−; CK20+/CK7+; CK20−/CK7+; and CK20−/CK7−.2