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Home Based Pet Business
Wholesale Pet Supplies: PetStoresUSA has provided millions of dollars of dog supplies, cat supplies and other pet supplies to pet supply retailers across the country for over Fifty Years. We ship Pet Supplies from our warehouse to your store when you need them and for the price you need.
Drop Ship Pet Supplies: PetStoresUSA is the leading supplier of drop ship services to the pet industry. Our technology and our people ensure that your customer receives their product directly to their home or office. All orders ship within 24 hours, most ship that same day. We provide integrated drop ship solutions for pet product manufacturers, and drop ship services for pet supply retailers.
Retail Pet Supply Solutions: PetStoresUSA provides wholesale pet supplies directly to your store. If you need dog supplies, cat supplies, or other pet supplies, we have it. No matter how small or how large your dog supply, cat supply or pet supply needs are, we are there for you. We offer a great assortment of common pet supplies and the hard to find pet supplies. Need a booster bath, a heated dog bed, or even a cool dog bed, we have them. Need a bark collar or training collar, or a dog stroller or cat stroller, we have those too. Dog supply and cat supply are our specialty!
Pet Supply Manufacturer Solutions: We offer distribution solutions for your pet supplies. Our large and growing customer base is always looking for great dog, cat or other pet products. It does not matter if you are an established manufacturer offering main stream pet supplies or you offer unique pet supplies, PetStoresUSA can help. Our advanced technology and dedication to service has made us the choice for many Pet Supply Manufacturers and Pet Supply Retailers.
Web Site Builder: PetStoresUSA is the leading provider of pet related web sites in the country. With our proprietary software you can design your own web site, promote your pet store, reach more customers and earn more. It is simple to use. You do not need to know any programming languages or need a degree in computer science. Our proprietary software powers web sites for pet stores, dog trainers, cat sitters, pet boarding kennels, dog breeders and more.
Web Site Design: PetStoresUSA is a leader in web design services for the pet industry. For those who need more specific solutions and outstanding custom designed web sites we have the people, plus we know the industry, the products and can deliver a web site which meets and exceeds your needs. We offer our services not only to pet supply retailers, but also supply manufacturers. We know web design, we know ecommerce and most important we know pets, and the pet industry. If your current site needs a face lift or you simply need a first or new site, we can help.
Ecommerce: The fastest growing market channel is ecommerce. We offer solutions for everyone. If you love dogs, cats, pets of all kind but have no background in programming, design, ecommerce we have the solution. PetStoresUSA offers a fully loaded turn key ecommerce web site. Use this ecommerce solution with our web site builder or simply use it with your existing web site. When the customer orders pet supplies from you, we process the order and ship the order for you. This is a turnkey solution for pet supplies and pet profits. This turnkey solution is currently providing extra income for independent pet stores, chain pet stores, even dog trainers, veterinarians, dog and cat breeders and more, nationwide. This is a pet supply and ecommerce solution that works and can work for you. PetStoresUSA also offers advanced custom ecommerce solutions and packages for large and growing internet pet retailers.
Search Engine Optimization (SEO): PetStoresUSA has been providing SEO for pet manufacturers, pet distributors and pet retailers for over a decade. If your web site cannot be seen on the Internet by your potential customers you are not optimizing the potential of you site. We have a staff which has years of experience with a successful core focused on the pet industry. If you want to be seen on the Internet, call us!


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Acclaimed playwright Tyler Perry explores the hardships of marriage and the benefits of confronting problems in this drama about the stressful union between a hardworking accountant and his loving wife, a harried marriage counselor. Roger Jackson strives to support his family, a group that includes not only his Ivy League-educated wife Judith (Jurnee Smollett-Bell), but his ganja-smoking father Stanley and her Bible-thumping mother TT as well. Meanwhile, Judith doles out thoughtful advice to couples every day, yet remains completely powerless when it comes to addressing the issues surrounding her own troubled marriage. When an old college friend drops by her office, Judith faces her biggest personal challenge to date. Perry previously brought this tale to the big screen with a filmed stage version in 2008. ~ Jeremy Wheeler, Rovi
Movies.com, the ultimate source for everything movies, is your destination for new movie trailers, reviews, photos, times, tickets + more! Stay in the know with the latest movie news and cast interviews at Movies.com.
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This is to express my deep interest in applying for your Master program of " ----" starting on September 2013. I would like to express my appreciation for the opportunity to apply for this program under the ---- project I just have graduated from the faculty of Tourism and Hotels, --- University, majoring in the speciality of Tourist Guiding .
During my four-year study I showed great academic attitude and intense interest in my major. Also I was working as an assistant manager for 3 years in a tourism agency. I preferred to work during my studying to gain much experience in the field of tourism. Through the precious four-year academic study and three-year working experience, I acquired substantial academic background and high sense of duty and discipline. Now I am confident that the working experience combined with my academic knowledge will be an important asset for my realization in the field of tourism management .
The opportunity to pursue a master's course in " xxx " from " xxx" represents the next challenge in my life . This opportunity gives me the chance to deepen my tourism studies in the inspiring, creative and cosmopolite environment of one of the largest British university, moreover the great opportunity to get in touch with the British culture and the new educational system. I believe that my current vision is the main reason that drives me to study in a well reputed university where the high quality of education is being provided .
My ultimate goal is to be an expert researcher in tourism management and preparing for the PhD after having my master degree. In addition to living and breathing the international atmosphere and meeting my fellow researchers, from whom I will learn much about xxxx. I am sure, if I am granted this scholarship to pursue my master degree in the xxx University, I will benefit greatly from the extra ordinary experience, for building up my professional career for the development of my homeland .
I hope this application receives your favourable consideration and I will be patiently waiting for your positive reply .
Is this letter what we call a 'covering letter' which is to be sent with your formal application for a scholarship? For editing purposes I need to have more information to judge what is suitable content for your letter.


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£126.00£180.00(Save 30%)
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Blacks Outdoor Retail Limited (t/a "Millets") acts as a broker and offers finance from a restricted range of finance providers. PayPal Credit is a trading name of PayPal (Europe) S.à.r.l. et Cie, S.C.A., 22-24 Boulevard Royal L-2449, Luxembourg.
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Robert has directed 2 feature films, over 30 documentaries, mostly about food, culture and the arts, and has lit and directed over 900 commercials for television. He has photo-illustrated many books, mostly about food and co-authored 11 photo-documentary books about people working and unemployment and has authored two books about photography. He has recently finished his first novel and a documentary about Monika Pagneux, one of Europe's leading theatre movement directors. Presently Robert is working on several films, an essay about America and a second novel.
Over the years Robert has also worked closely with a number of theatre companies and is now offering his skills through Theatre Images to arts and other companies, which are trying to make a difference.
Visit Robert's Website


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FoodSaver Vacuum Sealing System Giveaway
Sleek simplicity describes the FoodSaver V3880 Fully Automatic Vacuum Sealing System (MSRP: $179)
The FoodSaver® system keeps food fresh five times longer and prevents freezer burn.
It saves money because you can buy in bulk or when your favorite items go on sale and vacuum seal them, rather than having them go to waste.
Fully automatic operation makes this model easy to operate
Two vacuum speeds (normal and gentle) and two food settings (moist and dry), take the guesswork out of food preservation
Fully automatic operation auto detects FoodSaver® bag and starts vacuum sealing
Air-tight heat seal removes air from specially designed bags. 2 vacuum speeds automatically adjust based on food type. Pulse Vac feature allows complete manual control of air removal
2 seal levels that auto detect moist or dry food
Accessory mode for containers and canisters seals any FoodSaver® container air-tight
Helps with meal preparation – the Marinate Mode allows you to take an entire day out of the cooking process
With the touch of a button, and the FoodSaver® Marinator (sold separately), you can infuse meats, poultry, fish and vegetables with flavor in minutes rather than overnight
Patented removable drip trip catches overflow liquids and is dishwasher safe
Conveniently stores the rolls and built in cutter to create custom-sized bags
Starter kit includes: 1 – 11 inch x 18 feet heat seal roll and 12 – quart-sized heat seal bags
Meat, poultry, or fish are probably the first items that come to mind, but you can vacuum seal just about anything.
Food and recipes you can seal that you may not have thought about include:
Bread, rolls, and English Muffins
Raisin Bread for Raisin Lovers
Cinnamon Raisin English Muffin Bread with Cinnamon Sugar Butter
Seal berries when they're in season – blueberries, strawberries, and cherries are especially great. Use them later to make cakes, muffins, or bars with
Blueberry Yogurt Cake with Lemon Vanilla Glaze
Blueberry Muffins with Raspberry Jam Swirls
Chocolate Chip and Cherry Blondies
Seal Fruit – Use it in recipes, baking, or for smoothies
Caramel Apple Bars (GF with Vegan adaptation)
Blueberry Banana Recovery Smoothie (vegan, GF)
Seal fresh herbs, like parsley, thyme, oregano or rosemary to use in your favorite dishes
Rosemary Chipotle Roasted Almonds (vegan, GF)
Lemon Rosemary Coconut Oil Roasted Vegetables (vegan, GF)
Seal vegetables of any kind
Caribbean Citrus Roasted Sweet Potatoes (vegan, GF)
Baked Parsnip Fries with Creamy Balsamic Reduction Dip (vegan, GF)
Roasted Cinnamon-Ginger Delicata Squash (vegan, GF)
Lemon Rosemary Coconut Oil Roasted Vegetables (vegan, GF)
Seal Fish and Seafood
Szechuan Shrimp Stir Fry with Fried Rice
Pan Seared Caribbean Citrus Mahi Mahi with Brown Rice Noodles
Orange Glazed Chilean Sea Bass with Mustard Dill Cucumber and Orange Champagne Relish
Seal Sauces and Soups
Creamy Tomato Soup (vegan, gluten-free)
Sweet Potato Red Pepper and Coconut Milk Soup (vegan, gluten-free, soy-free, microwave-friendly)
Holiday cookies in advance of cookie exchanges or extra cookies of any kind
Molasses Triple Chocolate Cookies
Cranberry and White Chocolate Chip Cookies
Peanut Butter Chocolate Chunk Cookies
Chocolate Chip and Chunk Cookies
Seal extra baking supplies –dried fruit, raisins chocolate chips, baking chips, marshmallows, toffee bits
Extra Brownies and Bars
Fudgy Nutella Brownies with Cream Cheese Frosting
Cranberry Bliss Bars {Starbucks Copycat Recipe}
Seal Healthy Granola Bars
Peanut Butter Chocolate Chip Granola Bars (no-bake, vegan, GF)
Snickerdoodle Cookie Granola Bars (no-bake, vegan, GF)
Sunflower Seed Butter Granola Bars with Chocolate Drizzle (no-bake, vegan, GF)
There's very little you can't seal, really.
Using Rafflecopter, enter to win a the FoodSaver V3880 Fully Automatic Vacuum Sealing System by making sure to leave a blog comment below in response to the first question.
Then follow the prompts for additional entries.


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A magazine about discovery
The Collective Quarterly journeys to one place per issue. When we travel, we're trying to discover the essence of a region during a moment in time. But what happens when there are stories that demand to be told but don't fit inside a specific print issue? Stories about uncommon people, places, and things from around the world?
They're told here.


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It's a new month, with new movies on XFINITY On Demand. Use this schedule to help plan which movies you want to watch. Click on a title and get taken to a page where you can watch previews, begin the purchase process from your computer, or add the movie to your queue if it's not available and we'll notify you when it is available on XFINITY On Demand. Find even more movies by clicking here.
[iframe http://edge.cim-img.top.comcast.net/CTV02/Comcast_CIM_Internal_Ingest_Browse_Videos/13/913/VOD_Aug_8-1.html 615 1350]
The opinions expressed are solely those of the author and do not necessarily reflect the views of Comcast.


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+972 Magazine
A call to support the Orthodox majority opposing extremism
In the struggle within the Orthodox Jewish community between reactionaries who use Judaism as a weapon against democracy, and modernists whose worldview is based on integrating the two, the reactionaries have been the dominant voice - but the silent majority is starting to raise its own. By Rachel Liel It cannot be easy to be a modern Orthodox Jew in Israel today, not when leading voices in the community are calling for Israel to reject the modern, democratic world. The latest such declaration came from Benny Katsover, an "elder statesman" of the West Bank settler movement. "The main role of…Read More... | 15 Comments


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Saddleback College students, faculty, staff, and administrators gathered at the future site of the college's new Sciences Building on Monday, December 16th for a groundbreaking ceremony to celebrate construction of the building, slated to open in 2015.
South Orange County Community College District Board of Trustees members in attendance included T.J. Prendergast, III, president, Marcia Milchiker, clerk, Dr. William Jay, Tim Jemal, David Lang, and Dr. James Wright. Chancellor Gary Poertner and President Tod A. Burnett offered remarks that noted the significance of the new building, and Dr. Wright thanked the board of trustees, chancellor, and president for their work in facilitating the funding of construction.
Dr. Burnett stated, "Our new Sciences Building will be a model in the state for its environmentally-friendly design and state-of-the art laboratories and classrooms, providing a top-notch learning environment for our students. Thank you to our facilities and maintenance staff for their superb oversight of this long-awaited project."
The 51,244 square foot, three-floor building will house 26 modern laboratory spaces for academic programs in astronomy, biology, chemistry, geology, marine science, and physics. The new building will be Leadership in Energy and Environmental Design (LEED) certified and will include many sustainable design features, including a courtyard with a themed demonstration garden planted over an underground element to provide on-site retention of storm water, reducing the impact on the campus storm water system.
Photo (from left to right): South Orange County Community College District Board of Trustees Members David Robinson, Tim Jemal, Dr. James Wright, David Lang, T. J. Prendergast, Dr. William Jay, and Marcia Milchiker; Associated Student Government President Bahman Sabahi; Academic Senate President Dan Walsh; District Director of Facilities Planning Walter Rice; Irvine Valley College President Glenn Roquemore; College Director of Facilities John Ozurovich; Classified State Employees Association Representative and Senior Lab Technician Sara Sheybani; Brian Dougherty (architect, Dougherty and Doughtery); Dean of Mathematics, Science, and Engineering Chris McDonald, Dave McGlothlin (senior project manager, CW Driver), Biology Professor Tony Huntley, Chancellor Gary Poertner, President Tod A. Burnett.


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Hey, dark eyes, rest with me a while as I drift closer to sleep. But still cannot find no peace shinouh
maybe there's a universe out there — happening now — where we end up together. if you think of it all this way, then it's like neither of us did anything wrong. you just found me in the wrong universe. that's all. because you could have loved me forever. and maybe in another universe, i let you. shipwhore: I WILL GO DOWN WITH THESE SHIPS


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North Central Texas (NCT) Safe Room Rebate Program
We are not accepting applications at this time. However, the North Central Texas Council of Governments (NCTCOG) has opened an online waitlist for the North Central Texas Safe Room Rebate Program. This waitlist is open to all jurisdictions in the 16 county NCTCOG region and will not close. You can sign up for the waitlist below.
As we receive additional funding, we will begin contacting those on the waitlist in the order in which submissions were received. The anticipated timeframe to be contacted regarding placement in the program may be from 18 to 24 months.
However, please be aware that the waitlist has over 8,500 people on it and each round of funding released supplies around 30 shelters for each county in the NCTCOG region. Additionally, this program is not retroactive. Therefore any shelter installed before the receipt of an official award packet does not qualify for rebate.
Those who have already submitted an application for the Metro Safe Room Rebate Program do not need to reapply. Those who have already registered will not be able to log into the website until they are moved from the waitlist to the program list.
To participate in the program applicants must:
If the home is 45 years old or older, a review from the State Historical Preservation Office (SHPO) will be requested by NCTCOG on the applicant's behalf prior to the applicant being approved to receive a rebate. This does not deem the applicant ineligible, it is just an additional review phase required under certain conditions.
Program Overview [pdf]


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Stop the Monsanto Protection Act
"One of the most outrageous special interest provisions in years." That's what Senator Jeff Merkley (D-OR) calls the Monsanto Protection Act, which became law in March.1
Now we have an opportunity to stop it. Senator Merkley has proposed an amendment to the Senate Farm Bill that would repeal the Monsanto Protection Act – but it will take serious grassroots pressure to even make sure the amendment comes up for a vote.
Tell the Senate: Repeal the Monsanto Protection Act
Cynically dubbed the "Farmer Assurance Provision," this provision allows Monsanto and other companies to ignore existing food safety rules, and continue selling genetically modified seeds even if a court has blocked them from doing so.
Even worse is how this shameful giveaway became law. It was inserted anonymously and without review or debate into the must-pass budget bill to avoid government shutdown in March.
CNN said that "the law passed without most of Congress even knowing about it."2 Jon Stewart put it a different way: "The laws of the most powerful nation on earth are written with the same level of accountability as internet comments."3
Even from our dysfunctional Congress, this was stunning. Tell the Senate: Repeal the Monsanto Protection Act.
Our system of ensuring the safety of genetically modified foods is already insufficient, and wrought with industry influence. The FDA and USDA routinely approve foods without sufficient review, and often rely on shoddy industry-generated studies to determine the safety of GMO foods.
The courts provide a vital check to allow us to challenge approvals that were conducted too hastily – as when federal courts found the USDA's 2009 approval of Monsanto's GMO sugar beets to have been based on an insufficient review.
But the Monsanto Protection Act strips the courts of the power to halt seed sales, and actually compels the USDA to approve products whose approval the courts have challenged. It's so outrageous, the USDA says the provision might not be enforceable.4
Now our legislators have an opportunity to undo this appalling act of putting special interests like Monsanto ahead of our health and the safety of our food. Urge the Senate to take action now.
1. "'Monsanto Protection Act' Repeal Effort Officially Backed By Sen. Jeff Merkley," Huffington Post, 5/20/13
2. "Last Minute Legislation: Bad for Our Health," CNN, 3/29/13
3. "Jon Stewart explains the 'Monsanto Protection Act'," Mother Nature Network, 4/12/13
4. "Group says Monsanto law skirts courts, requires approval of genetically engineered seeds," Politifact, 3/29/13


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The Old Stables
We have just completed a fabulous renovation on a converted stable into a luxury one bedroom self catering let. The property has private off street parking, a double bedroom, a fully fitted kitchen/lounge and bathroom. We provide an excellent complimentary continental breakfast including cereals, pastries, yoghurts, fruit etc. Though we are located 5 miles south of Bath in the beautiful village of Hinton Charterhouse which has two excellent pubs we can offer you free parking in central Bath.
- 1 Queen bed
- 1 Bathroom
- Clock Radio
- En-suite Bathroom
- Tea/Coffee Maker
- Toaster
- Patio
- Internet Access
- Laundry Facilities
- Bathrobes Provided
- Broadband Internet Access
- Heating
- Shower
- Fireplace
- Microwave
- Fridge Freezer
- Shower - separate
- Linen and Towels Provided
- Television
- Cable/Satellite TV
- Wireless Internet
- Dishwasher
- Flat Screen TV
- Fridge
- Hairdryer
- Hob
- Iron/Ironing board
- Linen Provided
Terms & Conditions
Payment is on departure and we accept all major credit cards.
If cancelled up to 3 days before date of arrival, no fee will be charged.
If cancelled later, the first night will be charged.
In case of no-show, the total price of the reservation will be charged.


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This information is produced and provided by the National Cancer Institute (NCI). The information in this topic may have changed since it was written. For the most current information, contact the National Cancer Institute via the Internet web site at http://cancer.gov or call 1-800-4-CANCER.
Merkel cell carcinoma (MCC) was originally described by Toker in 1972 as trabecular carcinoma of the skin.[1] Other names include Toker tumor, primary small cell carcinoma of the skin, primary cutaneous neuroendocrine tumor, and malignant trichodiscoma.[2]
MCC is an aggressive neuroendocrine carcinoma arising in the dermoepidermal junction. (See Figure 1.) Although the exact origin and function of the Merkel cell remains under investigation, it is thought to have features of both epithelial and neuroendocrine origin and arise in cells with touch-sensitivity function (mechanoreceptors).[3,4,5,6,7,8,9]Figure 1. Merkel Cell Anatomy.
In Surveillance, Epidemiology and End Results (SEER) Program data from 1986 to 2001, the age-adjusted U.S. annual incidence of MCC tripled from 0.15 to 0.44 per 100,000, an increase of 8.08% per year. Although this rate of increase is faster than any other skin cancer including melanoma, the absolute number of U.S. cases per year is small. About 1,500 new cases of MCC were expected in the United States in 2007.[10,11,12,13,14,15]
MCC incidence increases progressively with age. There are few cases in patients younger than 50 years, and the median age at diagnosis is about 65 years (see Figure 2).[11] Incidence is considerably greater in whites than blacks and slightly greater in males than females.[10,11,12,13,15]Figure 2. . Frequency of MCC by age and sex of men (square) and women (circle). Reprinted from Journal of the American Academy of Dermatology, 49 (5), Agelli M and Clegg L, Epidemiology of primary Merkel cell carcinoma in the United States, pp. 832–41, Copyright (2003), with permission from Elsevier.
The apparent increase in incidence may reflect an actual increase and/or more accurate diagnostic pathology tools, improved clinical awareness of MCC, an aging population, increased sun exposure in susceptible populations, and improved registry tools.
MCC occurs most frequently in sun-exposed areas of skin, particularly the head and neck, followed by the extremities, and then the trunk.[3,13,16] Incidence has been reported to be greater in geographic regions with higher levels of ultraviolet B sunlight.[13]
A 2009 review of 3,804 MCC cases from the SEER Program database from 1973–2000 tabulated the ten most common sites of MCC (see Table 1).[15]
In various cases series, up to 97% of MCCs arise in skin. Primaries in other sites were very rare, as are MCCs from unknown primary sites.[15]
SEER registry data have shown excess risk of MCC as a first or second cancer in patients with several primary cancers.[17] National cancer registries from three Scandinavian countries have identified a variety of second cancers diagnosed after MCC.[18]
Increased incidence of MCC has also been seen in people treated heavily with methoxsalen (psoralen) and ultraviolet A (PUVA) for psoriasis (3 of 1,380 patients, 0.2%), and those with chronic immune suppression, especially from chronic lymphocytic leukemia, human immunodeficiency virus, and prior solid organ transplant.[13,19]
In 2008, a novel polyomavirus (Merkel cell polyoma virus, MCPyV) was first reported in MCC tumor specimens [20], a finding subsequently confirmed in other laboratories.[21,22,23] High levels of viral DNA and clonal integration of the virus in MCC tumors have also been reported [24] along with expression of certain viral antigens in MCC cells and the presence of antiviral antibodies. Not all cases of MCC appear to be associated with Merkel cell polyomavirus infection.[25]
MCPyV has been detected at very low levels in normal skin distant from the MCC primary, in a significant percentage of patients with non-MCC cutaneous disorders, in normal appearing skin in healthy individuals, and in nonmelanoma skin cancers in immune-suppressed individuals.[8,26,27,28] Various methods have been used to identify and quantify the presence of MCPyV in MCC tumor specimens, other non-MCC tumors, blood, urine, and other tissues.[29,30]
The significance of the new MCPyV findings remains uncertain. The prognostic significance of viral load, antibody titer levels, and the role of underlying immunosuppression in hosts (from disease and medications) are under investigation.
Prevalence of MCPyV appears to differ between MCC patients in the the United States and Europe versus Australia. It has been suggested that there may be two independent pathways for the development of MCC: one driven by the presence of MCPyV, and the other driven primarily by sun damage, especially as noted in patient series from Australia.[21,25,31]
Although no unique marker for MCC has been identified, a variety of molecular and cytogenetic markers of MCC have been reported.[5,8,14]
Clinical Presentation
MCC usually presents as a painless, indurated, solitary dermal nodule with a slightly erythematous to deeply violaceous color, and rarely, an ulcer. MCC can infiltrate locally via dermal lymphatics, resulting in multiple satellite lesions. Because of its nonspecific clinical appearance, MCC is rarely suspected prior to biopsy.[3] Photographs of MCC skin lesions illustrate its clinical variability.[32]
A mnemonic [16] summarizing typical clinical characteristics of MCC has been proposed:
Not all patients have every element in this mnemonic; however, in this study, 89% of patients met three or more criteria, 52% met four or more criteria, and 7% met all five criteria.[16]
Initial Clinical Evaluation
Because local-regional spread is common, newly diagnosed MCC patients require a careful clinical examination that includes looking for satellite lesions and regional nodal involvement.
An imaging work-up should be tailored to the clinical presentation as well as any relevant signs and symptoms. There has been no systematic study of the optimal imaging work-up for newly diagnosed patients, and it is not clear if all newly diagnosed patients, especially those with the smallest primaries, benefit from a detailed imaging work-up.
If an imaging work-up is performed, it may include a computed tomography (CT) scan of the chest and abdomen to rule out primary small cell lung cancer as well as distant and regional metastases. Imaging studies designed to evaluate suspicious signs and symptoms may also be recommended. In one series, CT scans had an 80% false-negative rate for regional metastases.[33] Head and neck presentations may require additional imaging. Magnetic resonance imaging has been used to evaluate MCC but has not been studied systematically.[34] Fluorodeoxyglucose-positron emission tomography results have been reported only in selected cases.[35,36] Routine blood work as a baseline has been recommended but has not been studied systematically. There are no known circulating tumor markers specifically for MCC.
Initial Staging Results
The results of initial clinical staging of MCC vary widely in the literature, based on retrospective case series reported over decades. In 2009, 3,870 MCC cases were reported from the SEER Program registry. For invasive cancers, 48.6% were localized, 31.1% were regional, and 8.2% were distant.[15]
MCC that presents in regional nodes without an identifiable primary lesion is found in a minority of patients, with the percent of these cases varying among the reported series. Tumors without an identifiable primary lesion have been attributed to either spontaneous regression of the primary or metastatic neuroendocrine carcinoma from a clinically occult site.[6,15,16,37,38]
Clinical Progression
In a review of patients from 18 case series, 279 of 926 patients (30.1%) developed local recurrence during follow-up, excluding those presenting with distant metastatic disease. These events have been typically attributed to inadequate surgical margins and/or a lack of adjuvant radiation therapy. In addition, 545 of 982 patients (55.5%) had lymph node metastases at diagnosis or during follow-up.[6]
In the same review of 18 case series, the most common sites of distant metastases were distant lymph nodes (60.1%), distant skin (30.3%), lung (23.4%), central nervous system (18.4%), and bone (15.2%).[6] Many other sites of disease have also been reported, and the distribution of metastatic sites varies among case series.
In one series of 237 patients presenting with local or regional disease, the median time-to-recurrence was 9 months (range, 2–70 months). Ninety-one percent of recurrences occurred within 2 years of diagnosis.[39]
Potential Prognostic Factors
The extent of disease at presentation appears to provide the most useful estimate of prognosis.[5]
Diagnostic procedures, such as sentinel lymph node biopsy, may help distinguish between local and regional disease at presentation. One-third of patients who lack clinically palpable or radiologically visible nodes will have microscopically evident regional disease.[33] The likelihood is that nodal positivity may be substantially lower among patients with small tumors (e.g., ≤1.0 cm).[40]
Many retrospective studies have evaluated the relationship of a wide variety of biological and histological factors to survival and local-regional control.[5,6,15,33,39,41,42,43,44,45,46,47,48,49,50,51,52][Level of evidence: 3iiiDiii] Many of these reports are confounded by small numbers, potential selection bias, referral bias, short follow-up, no uniform clinical protocol for both staging and treatment, and are underpowered to detect modest differences.
A large, single-institution, retrospective study of 156 MCC patients, with a median follow-up of 51 months (range 2–224 months), evaluated histologic factors potentially associated with prognosis.[50][Level of evidence: 3iiiB] Although this report is subject to potential selection and referral bias, both univariate and multivariate analyses demonstrated a relationship between improved cause-specific survival and circumscribed growth pattern versus infiltrative pattern, shallow-tumor depth versus deep-tumor depth, and absence of lymphovascular invasion versus presence of lymphovascular invasion. Adoption of these findings into a global prognostic algorithm awaits independent confirmation by adequately powered studies.
A 2009 study investigated whether the presence of newly identified MCPyV in MCC tumor specimens influenced clinical outcome among 114 Finnish patients with MCC. In this small study, patients whose tumors were MCPyV+ appeared to have better survival than patients whose tumors were MCPyV-.[53][Level of evidence: 3iiiDiii] Standardization of procedures to identify and quantify MCPyV and relevant antibodies is needed to improve understanding of both prognostic and epidemiologic questions.[8]
The bulk of MCC literature is from small case series, which are subject to many confounding factors (refer to the Prognostic Factors section of this summary). For this reason, the relapse and survival rates reported by stage vary widely in the literature. In general, lower-stage disease is associated with better overall survival.[54]
Outcomes from patients presenting with small volume local disease and pathologically confirmed cancer-negative lymph nodes report a cause-specific 5-year survival exceeding 90% in one report.[39,50][Level of evidence: 3iiiDiii]
A tabular summary of treatment results of MCC from 12 series illustrates the difficulty in comparing outcome data among series.[5]
Using the SEER Program registry MCC staging system adopted in 1973, MCC survival data (1973–2006) by stage is summarized below:[15]Figure 3. Relative ten-year survival rates for Merkel Cell Carcinoma by stage (SEER 1973–2006). Albores-Saavedra J et al: Merkel cell carcinoma demographics, morphology, and survival based on 3,870 cases: A population-based study. J Cutan Pathol. Reprinted with permission © 2009. Published by Wiley-Blackwell. All rights reserved.
Although the exact origin and function of the Merkel cell remains under investigation, it is thought to have features of both epithelial and neuroendocrine origin and arise in cells with touch-sensitivity function (mechanoreceptors).[1,2,3,4]
Characteristic histopathologic features include dense core cytoplasmic neurosecretory granules on electron microscopy and cytokeratin-20 on immunohistochemistry (see Figure 4).[5]
A panel of immunoreagents (see Figure 4) helps to distinguish Merkel cell carcinoma (MCC) from other similar-appearing tumors including neuroendocrine carcinoma of the lung (i.e., small cell carcinoma), lymphoma, peripheral primitive neuroectodermal tumor, metastatic carcinoid tumor, and small cell melanoma.[5]Figure 4. Merkel - Immunohistochemical differential diagnosis of Merkel-Cell Carcinoma (Typical Staining Pattern).
Histologically, MCC has been classified into three distinct subtypes: [6,7,8,9]
Mixtures of variants are common.[6,7,8] Although some small, retrospective case series have suggested correlations between certain histologic features and outcome, the evidence remains uncertain.[10,11,12]
One group has suggested a list of 12 elements that should be described in pathology reports of resected primary lesions and nine elements to be described in pathology reports of sentinel lymph nodes. The prognostic significance of these elements has not been validated prospectively.[13]
If the following data are recorded for every MCC patient, any patient can be staged with the existing or new staging system:
The College of American Pathologists has published a protocol for the examination of specimens from patients with MCC of the skin.[14]
(Refer to the Stage Information section of this summary for more information.)
The histologic variants of MCC are shown in Figure 5. [15]Figure 5. (A) Intermediate variant of MCC showing vesicular, basophilic nuclei with prominent nucleoli and multiple mitoses. (B) Small-cell variant, histologically indistinguishable from bronchial small-cell carcinoma. (C) Trabecular variant is rare and normally only seen as a small component of a mixed variant. Goessling W et al: Merkel Cell Carcinoma, J Clin Oncol, 20 (2), pp. 588–98. Reprinted with permission. © 2009 American Society of Clinical Oncology. All rights reserved.
Previously, five competing staging systems have been used to describe Merkel cell carcinoma (MCC) in most publications.
These staging systems are highly inconsistent with each other. Indeed, stage III disease can mean anything from advanced local disease to nodal disease to distant metastatic disease. Furthermore, all MCC staging systems in use have been based on fewer than 300 patients.
Definitions of TNM
To address these concerns, a new MCC-specific consensus staging system was developed by the American Joint Committee on Cancer (AJCC) to define Merkel cell carcinoma, as shown in tables 3, 4, 5, and 6.[7] Prior to the publication of this new system, the AJCC advocated using the nonmelanoma staging system.
Before the new AJCC consensus staging system was published, the most recent MSKCC four-stage system was favored because it was based on the largest number of patients and was the best validated.[1] The stages in the MSKCC system included:
One group has suggested a list of 12 elements that should be described in pathology reports of resected primary lesions and nine elements to be described in pathology reports of sentinel lymph nodes. The prognostic significance of these elements has not been validated prospectively.[8] The 2009 AJCC staging manual also specifies a variety of factors which should be collected prospectively on pathology reports.
Merkel cell carcinoma (MCC) is an uncommon tumor. Most clinical management recommendations in the literature are based on case series that describe a relatively small number of patients who were not entered on formal clinical trials, evaluated with uniform clinical staging procedures, treated with uniform treatment protocols, or provided with regular, prescribed follow-up. These reports are also confounded by potential selection bias, referral bias, and short follow-up; and they are underpowered to detect modest differences in outcome.
In addition, outcomes of patients with American Joint Committee on Cancer stage IA, stage IB, and stage II are often reported together. In the absence of results from clinical trials with prescribed work-up, treatments, and follow-up, most MCC patients have been treated using institutional or practitioner preferences that consider the specifics of each case as well as patient preference.
Two competing philosophies underlie many of the controversies about the most appropriate method of treating MCC. In the first philosophy, MCC is treated like other nonmelanoma skin cancers, with an emphasis on treating local-regional disease with surgery and radiation as appropriate. In the second philosophy, MCC is treated according to its "biologic features." This would make it analogous to small cell lung cancer, which is assumed to be a systemic disease, and would lead to a more routine recommendation of systematic adjuvant chemotherapy.[1]
Surgery for the Primary Lesion
In a review of 18 case series, 279 of 926 patients (30.1%) developed local recurrence during follow-up, excluding those presenting with distant metastatic disease at presentation. These recurrences have been typically attributed to inadequate surgical margins or possibly a lack of adjuvant radiation therapy.[2,3]
Given the propensity of MCC to recur locally (sometimes with satellite lesions and/or in-transit metastases), wide local excision to reduce the risk of local recurrence has been recommended for patients with clinical stage I or stage II disease.
Recommendations about the optimal minimum width and depth of normal tissue margin that should be excised around the primary tumor differ among the various retrospective case series, but this question has not been studied systematically.[3,4,5,6,7][Level of evidence: 3iiiDiii] No definitive data suggest that extremely wide margins improve overall survival (OS), although some reports suggest that wider margins appear to improve local control.[3][Level of evidence: 3iiiDiii] Frozen-section evaluation of margins may be useful, especially when the tumor is in an anatomical site that is not amenable to wide margins.
Some authors have advocated the use of Mohs micrographic surgery as a tissue-sparing technique. The relapse rate has been reported to be similar to or better than that of wide excision, but comparatively few cases have been treated in this manner and none in randomized, controlled trials.[7,8,9,10][Level of evidence: 3iiiDiii]
Regional Lymph Node Surgery
In some case series, local-regional recurrence rates are high when pathologic nodal staging is omitted. Surgical nodal staging in clinically negative patients has identified positive nodes in at least 25% to 35% of patients.[4,11,12][Level of evidence: 3iiiDiii] In one retrospective series of 213 patients who underwent surgical treatment of the primary tumor and evaluation of the draining nodes, nodal positivity was found in 2 of 54 patients with small tumors (e.g., ≤1.0 cm) and 51 of 159 patients with tumors greater than 1.0 cm.[13][Level of evidence: 3iiiDiii]
The role of elective lymph node dissection (ELND) in the absence of clinically positive nodes has not been studied in formal clinical trials. In small case series, ELND has been recommended for larger primary tumors, tumors with more than ten mitoses per high-power field, lymphatic or vascular invasion, and the small-cell histologic subtypes.[14,15,16][Level of evidence: 3iiiDiii]
Recently, sentinel lymph node (SLN) biopsy has been suggested as a preferred initial alternative to complete ELND for the proper staging of MCC. SLN biopsy has less morbidity than complete nodal dissection. Furthermore, for MCC sites with indeterminate lymphatic drainage, such as those on the back, SLN biopsy techniques can be used to identify the pertinent lymph node bed(s). If performed, SLN biopsy should be done at the time of the wide resection, when the local lymphatic channels are still intact.
Several reports have found the use of SLN biopsy techniques in MCC to be reliable and reproducible.[17,18,19,20] However, the significance of SLN positivity remains unclear.
In the absence of adequately powered, prospective, randomized clinical trials, the following questions remain:[4,12,21,24][Level of evidence: 3iiiDiii]
At present, the primary role of lymph node surgery is for staging and guiding additional treatment.
Based on a small number of retrospective studies, therapeutic dissection of the regional nodes after a positive SLND appears to minimize but not totally eliminate the risk of subsequent regional node recurrence and in-transit metastases.[4,21,24][Level of evidence: 3iiiDiii] There are no data from prospective randomized trials demonstrating that definitive regional nodal treatment with surgery improves survival.
Radiation Therapy
Because of the aggressive nature of MCC, its apparent radiosensitivity, and the high incidence of local and regional recurrences (including in-transit metastases after surgery alone to the primary tumor bed), some clinicians have recommended adjuvant radiation therapy to the primary site and nodal basin. Nodal basin radiation in contiguity with radiation to the primary site has been considered, especially for patients with larger tumors, locally unresectable tumors, close or positive excision margins that cannot be improved by additional surgery, and those with positive regional nodes, especially after SLND (stage II).[10,11,14,15,25][Level of evidence: 3iiiDiii] Several small, retrospective series have shown that radiation plus adequate surgery improves local-regional control compared to surgery alone, [2,5,26,27,28,29] whereas other series did not show the same results.[4,8][Level of evidence: 3iiiDiii]
In the absence of adequately powered, prospective, randomized clinical trials, the following questions remain:[4,8,9,12,21,24,26,30,31,32,33,34][Level of evidence: 3iiiDiii]
Because of the small size of these nonrandomized, retrospective series, the precise benefit from radiation therapy remains unproven.
When recommended, the radiation dose given has been at least 50 Gy to the surgical bed with margins and to the draining regional lymphatics, delivered in 2 Gy fractions. For patients with unresected tumors or tumors with microscopic evidence of spread beyond resected margins, higher doses of 56 Gy to 65 Gy to the primary site have been recommended.[5,10,11,14,15,27,31,35][Level of evidence: 3iiiDiii] These doses have not been studied prospectively in clinical trials.
Local and/or regional control of MCC with radiation alone has been reported in small, highly selected, nonrandomized case series of patients with diverse clinical characteristics.[29,36] Typically, these patients have had inoperable primary tumors and/or nodes or were considered medically inappropriate for surgery.[29,36][Level of evidence: 3iiiDiii]
Retrospective Surveillance, Epidemiology and End Results Program data suggest a survival value for adding radiation to surgery, but the conclusions are complicated by incomplete patient data, no protocol for evaluation and treatment, and potential sampling bias.[32] Prospective randomized clinical trials will be required to assess whether combining surgery with radiation therapy affects survival.[33,34][Level of evidence: 3iiiDiii]
A variety of chemotherapy regimens have been used for patients with MCC in the settings of adjuvant, advanced, and recurrent therapy.[5,34,37,38] [Level of evidence: 3iiiDiii] Even though no phase III clinical trials have been conducted to demonstrate that adjuvant chemotherapy produces improvements in OS, some clinicians recommend its use in most cases because of the following:
When possible, patients should be encouraged to participate in clinical trials.
From 1997 to 2001, the Trans-Tasman Radiation Oncology Group performed a phase II evaluation of 53 MCC patients with high-risk, local-regional disease. High risk was defined as recurrence after initial therapy, involved lymph nodes, primary tumor greater than 1 cm, gross residual disease after surgery, or occult primary with positive nodes. Therapy included local-regional radiation (50 Gy in 25 fractions), synchronous carboplatin (area under the curve [auc] 4.5), and intravenous etoposide (89 mg/m2 on days 1–3 in weeks 1, 4, 7, and 10). Surgery was not standardized for either the primary or the nodes, and 12 patients had close margins, positive margins, or gross residual disease. Twenty-eight patients had undissected nodal beds, and the remainder had a variety of nodal surgeries. With a median follow-up of 48 months, 3-year OS, local-regional control, and distant control were 76%, 75% and 76%, respectively. Radiation reactions in the skin and febrile neutropenia were significant clinical acute toxicities. Given the heterogeneity of the population and the nonstandardized surgery, it is difficult to infer a clear treatment benefit from the chemotherapy.[39][Level of evidence: 3iiiA]
In a subsequent report, the same investigators evaluated a subset of these protocol patients (n = 40, after excluding patients with unknown primaries) and compared them with 61 historical controls who received no chemotherapy, were treated at the same institutions, were diagnosed before 1997, and underwent no routine imaging staging studies. Radiation was given to 50 patients. There was no significant survival benefit seen for chemotherapy patients.[40]
In a subsequent, pilot, clinical trial of 18 patients from 2004 to 2006, the same investigators attempted to reduce the skin and hematological toxicity seen in Study 96-07. The drug schedule was changed to carboplatin (auc = 2) administered weekly during radiation beginning day 1 for a maximum of five doses, followed by three cycles of carboplatin (auc 4.5, and IV etoposide 80 mg/m2 on days 1–3 beginning 3 weeks after radiation and repeated every 3 weeks for three cycles). The radiation was similar to the earlier trial.[39] Early results suggest less toxicity, but other clinical outcomes have not yet been reported.[41]
Use of chemotherapy has also been reported in selected patients with locally advanced and metastatic disease. In one retrospective study of 107 patients, 57% of patients with metastatic disease and 69% with locally advanced disease responded to initial chemotherapy. Median OS was 9 months for patients with metastatic disease and 24 months for patients with locally advanced disease. At 3 years, OS was projected to be 17% and 35%, respectively. Toxicity was significant, however, and without clear benefit, particularly in older patients.[42][Level of evidence: 3iiiDiii]
The most appropriate follow-up techniques and frequency for patients treated for MCC have not been prospectively studied. Given the propensity for local and regional recurrence, clinicians should perform at least a thorough physical examination of the site of initial disease and the regional nodes. Imaging studies may be ordered to evaluate signs and symptoms of concern, or they may be performed to identify distant metastases early; but, there are no data suggesting that early detection and treatment of new distant metastases results in improved survival.
In one series of 237 patients presenting with local or regional disease, the median time-to-recurrence was 9 months (range, 2 months–70 months). Ninety-one percent of recurrences occurred within 2 years of diagnosis.[4] It has been suggested that the intensity of follow-up can be gradually diminished after 2 to 3 years as the majority of recurrences are likely to have occurred in this time frame.[4]
Current Clinical Trials
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with neuroendocrine carcinoma of the skin. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
Stage I and II Merkel cell carcinoma include patients with local disease only.
Standard treatment options:
Treatment options under clinical evaluation:
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage I neuroendocrine carcinoma of the skin and stage II neuroendocrine carcinoma of the skin. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
Stage III Merkel cell carcinoma includes patients with nodal disease.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage III neuroendocrine carcinoma of the skin. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
Stage IV Merkel cell carcinoma includes patients with distant metastases.
Chemotherapy may be considered for patients with stage IV disease who have a good performance status. Although responses have been seen with various regimens, evidence is lacking that chemotherapy results in permanent disease control or long-term survival.
In stage IV patients for whom chemotherapy is not considered an appropriate option, surgery and/or radiation therapy may be considered for local or regional palliation.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage IV neuroendocrine carcinoma of the skin. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
Merkel cell carcinoma is a rare tumor. There are no clinical trials reported for patients with recurrent disease exclusively. Recommendations and outcomes of various treatments for these patients are included in many large case series [1,2,3][Level of evidence: 3iiiDiii] and one phase II clinical trial.[4][Level of evidence: 3iiiA] Treatments are usually individualized based on patient preference and the specifics of each case, and there are no standard options. Consideration should be given to enrollment in clinical trials.
Local Recurrence
Treatment options for patients with local recurrence include wider local surgery if possible, followed by radiation if not previously given.
Regional lymph node dissection (RLND) can also be considered if regional draining nodes have not been previously removed.
Given the poor prognosis after recurrence, consideration can also be given to systemic chemotherapy, although there is no evidence that it improves survival.
Nodal Recurrence
Treatment options for patients with only regional nodal recurrence include RLND and adjuvant radiation therapy if the regional draining nodes have not been previously treated. Given the poor prognosis after recurrence, consideration can also be given to systemic chemotherapy, although there is no evidence that it improves survival.
Distant Recurrence
For patients with distant recurrence only, chemotherapy is an option for patients who have good performance status.[1,2,3,4,5,6][Level of evidence: 3iiiDiii] Although responses with chemotherapy have been reported in selected patients with locally advanced and metastatic disease, toxicity has been significant and without clear benefit, particularly in older patients. When appropriate, radiation therapy and/or surgery may be offered as palliation to sites of recurrence, particularly if chemotherapy is not considered an option.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with recurrent neuroendocrine carcinoma of the skin. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Editorial changes were made to this summary.
Purpose of This Summary
This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of merkel cell carcinoma. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.
Reviewers and Updates
This summary is reviewed regularly and updated as necessary by the PDQ Adult Treatment Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).
Board members review recently published articles each month to determine whether an article should:
Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary.
The lead reviewer for Merkel Cell Carcinoma Treatment is:
Any comments or questions about the summary content should be submitted to Cancer.gov through the Web site's Contact Form. Do not contact the individual Board Members with questions or comments about the summaries. Board members will not respond to individual inquiries.
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Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Adult Treatment Editorial Board uses a formal evidence ranking system in developing its level-of-evidence designations.
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The preferred citation for this PDQ summary is:
National Cancer Institute: PDQ® Merkel Cell Carcinoma Treatment. Bethesda, MD: National Cancer Institute. Date last modified <MM/DD/YYYY>. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/merkelcell/healthprofessional. Accessed <MM/DD/YYYY>.
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text:
Look Close—This '67 C10 Is Full of Surprises
To get the full effect, you'd need to come up from behind Greg Stanton's '67 C10 Stepside shortbed on the highway. From the rear, there's plenty to admire: the low stance, the modified tailgate and bed, the roll pan and flush-mounted taillights, the small-window cab, and the conservative gray paint.
But it's only when you start to pass, do you get what Greg calls "the surprise." A stream of metalflake seaweed flames reach along the rear fenders. As you pull alongside, the flames increase on the doors and front quarters, flowing from their starting place on the hood. A final glance in your rearview mirror reveals a hooded skull, grinning back at you from the front of the hood. More than you were expecting? That was Greg's plan all along.
Actually, the original plan was to build a stocker. The worn-out, slightly damaged Chevy belonged to a friend who owed Greg some money. Greg had half-seriously suggested "Just give me the truck and we're even." A month later, he came home to find the C10 parked in his driveway with a sign saying "we're even."
Greg and his then teenage son, Jeff, got busy on a simple resto project, but repairs led to modifications and, as Greg puts it, "Then it got crazy." Keeping crazy under control got easier after Greg teamed up with Jeff's Performance Garage in his hometown of Santa Rosa, California, where Jeff La Salle and Mark Rogers helped Greg finish the truck.
Earlier in the build, the truck was taken down to the framerails, which were boxed and supported with custom crossmembers to increase sturdiness. The 'rails were Z'd to bring the truck low to the ground. Just how low it'll go is up to Greg, who can control the ride height from the driver seat, thanks to RideTech airbag suspension at each corner. Rear trailing arms, and front and rear Rancho shocks were added to help smooth out any bumps in the road.
Power is provided by a brand-new 2012 Chevy ZZ4 crate engine, assembled by Jeff and Mark at Jeff's Performance Garage. The 350-inch small-block is naturally aspirated with a single Holley 770-cfm four-barrel carburetor on an aluminum dual-plane intake manifold. The aluminum radiator is from Be Cool. BBK shorty headers run into a custom-built exhaust system. Exhaust travels through 3-inch pipes and 16-inch Cherry Bomb mufflers, before exiting though quadruple pipes below each bed step. The stock Chevy Turbo 400 was kept in place. At the other end of the factory driveshaft is the factory rearend, with 3.74:1 gears and a limited-slip differential.
On any custom truck, it's the external impact that makes the first and most important impression. Greg obviously figured that out; the '67 has impact all over the place. The details like shaved door handles and trim pieces, smoothed driprails, and Hagan headlights might get overlooked, but they clean up the sheetmetal.
Greg intentionally left things simpler in the back in order to emphasize the wild paintjob (shot by George Borba at Geo's Chop Shop) in the front. The flames covering the entire hood, down the sides, and onto the top draw everyone's attention. But a closer look reveals another surprise usually missed at first glance—faint skulls painted in each of the triangular flame splits. Greg says not everybody notices it, and it takes a while for the ones who do. At car shows, spectators will discover those faces and come back in a few minutes with their friends to surprise them.
The bed isn't loaded with as many diabolical surprises. The tail section has been modified and a Classic Industries roll pan added to house the Hagan taillights and frenched license plate. Stake pockets have been filled, with the left rear pocket converted to a fuel fill tube with a motorcycle gas cap. The bed floor is African zebrawood. Greg spent seven hours choosing planks to match the grain. His friend, Adam Provencher, is a carpenter and constructed the floor. The front third is a hatch that opens for access to the battery.
Greg thanks Nick and Bud Simi at Precision Frame & Body Shop for helping with other bodywork. The fenders are filled with Americana five-spokes from Schott Performance Wheels. The 18s and 20s are matched with 235/45ZR18 and 275/40ZR20 Toyo Proxes 4 performance radials. A full set of disc brakes provides plenty of stopping power.
You'll find the flame theme carried over in the cab, via a Billet Specialties Flame wheel and matching pedals. Auto Meter Pro-Comp Ultra-Lite gauges fill a billet dash panel. The factory bench seat is covered in gray tuck 'n' roll vinyl.
The Chevy was completed in early 2012. Its first show was Peggy Sue's All-American Cruise in his own town. When his son Jeff, now in his 20s, and a bunch of buddies scrambled into the never-loaded bed and nothing rubbed, Greg knew his C10 was built right. And when car show crowds started gathering around the truck, he knew it looked right.
Greg loves the attention the truck gets at shows, but recently he's been talking about hooking a teardrop trailer to the C10's hitch and hitting the road with his wife Angie. We can picture the truck pulling that teardrop, letting other drivers get the full effect of the full-of-surprises C10 when it passes them on the highway.


text:
Cantor confronts GOP infighting
RICHMOND, Va. — House Majority Leader Eric Cantor is a rising star in national politics, but here at home, he's at the center of a battle with fellow Republicans.
His allies are maneuvering to pack leadership slots at the Republican Party of Virginia with like-minded figures — a move they hope will bring stability to a party with little money and lots of infighting.
Story Continued Below
That's infuriated some local conservatives, who feel they are being squeezed out of positions of power and aren't going down without a fight. They are rallying behind insurgent primary challenger Dave Brat, an economics professor with just $40,000 in the bank — compared to Cantor's $2 million.
While Brat has little chance of upsetting Cantor in the June 10 primary, the campaign and its supporters are making life a little tougher for Cantor, who will almost certainly become the next speaker of the House.
( Also on POLITICO: Cantor outlines House's agenda)
It's a reminder for the majority leader: His power and prominence in Washington could hurt him with conservatives in his district. Cantor's aides are aware of the need to minimize friction with the far right, but their internal polling shows that people who self-identify as members of the tea party overwhelmingly support Cantor.
Both Cantor and Speaker John Boehner (R-Ohio) have primary challenges this year.
"What we're talking about here is Eric Cantor disenfranchising and attacking the conservative base of his own party," said Larry Nordvig, a leader of the Richmond Tea Party. "And he's supposed to be a leader in the Republican Party. Good leaders don't attack their own people. I'm very upset about it. It's un-American. It's a cheap trick."
The right's angst with Cantor is a new phenomenon. When Republicans gained control of the House in 2011, Cantor was seen as the tea party's voice in leadership. But debt ceiling hikes and Cantor's support for immigration reform have given conservatives pause.
So far, Cantor's career has proceeded mostly without hiccup. He has served in his party's leadership for more than a decade and is in line to be the next speaker. His biggest challenge is remaining patient, as House Speaker John Boehner (R-Ohio) shows no signs of retiring soon.
( Also on POLITICO: Cantor hits primary opponent)
But his obstacles back home were on display at a recent meeting of the Hanover County Republican Party, held in a conference room at a Bass Pro Shop in Ashland. Brat's supporters at the gathering far outnumbered Cantor's, and the upstart challenger took the opportunity to lambaste Washington — and Cantor.
The central theme of Brat's campaign is that Cantor is beholden to business — specifically the U.S. Chamber of Commerce and the Business Roundtable.
"If you're in big business, Eric's been very good to you, and he gets a lot of donations because of that, right?" Brat said at the meeting. "Very powerful. Very good at fundraising because he favors big business. But when you're favoring artificially big business, someone's paying the tab for that. Someone's paying the price for that, and guess who that is? You."
Cantor's allies say that is exactly the type of rhetoric that has left the state party struggling for cash.
Though Cantor's team denies he is in any real electoral danger, they are not taking chances. He is running two commercials on Fox News in the Richmond and Washington television markets. One talks about Cantor standing up to President Barack Obama, and another claims that Brat worked for then-Gov. Tim Kaine, a Democrat who is now in the Senate. (Brat was on a statewide board of economists.)
( Also on POLITICO: Cantor up on air with TV ads)
Cantor is also running radio advertisements during conservative talk shows. Amid charges on the right that Cantor supports amnesty for illegal immigrants, the majority leader's aides sent reporters a description of a phone call with Obama, saying that he rebuffed the president's offer to work together on immigration reform. The White House responded by saying Obama simply called him to wish him a happy Passover.
"Yes, we are running a full campaign," said Ray Allen, Cantor's Richmond-based political brain. "But I would just suggest to you it's very in-character. We always run a full-on campaign. We never take anything for granted."
That aggressive posture is also on display at the statewide level. Republicans have fallen out of favor in Virginia, holding no statewide elected office for the first time in decades. Cantor is now the highest-ranking member of his party in the state. This leaves him — and his friends — with the responsibility of bolstering the Republican Party of Virginia, which is racked by infighting and has a paltry $28,070 in the bank.


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