Episode 23 - Testing patterns, patient and tumour characteristics and survival by BRAF genotype

In this episode of BJD Talks, Sam and Meera discuss the article ‘A national cohort study of melanoma BRAF status, testing patterns, patient and tumour characteristics, treatment and survival in England from 2016 to 2021’ by Mistry et al. The full article can be accessed at https://doi.org/10.1093/bjd/ljaf351 

*This podcast was generated by an AI tool created by 67Bricks for the British Association of Dermatologists* 

Transcript

SPEAKER_01 0:00

Welcome to BJD Talks, the official podcast of the BJD. I'm Sam.

SPEAKER_00 0:04

And I'm Mira. In this episode, we will be discussing the article by Kaelin Mystery et al., a national cohort study of melanoma, B RAF status, testing patterns, patient and tumour characteristics, treatment and survival in England from 2016 to 2021, published in September 2025 and included in the December 2025 issue.

SPEAKER_01 0:28

This study is important, not only because it tackles a key issue in melanoma care, but also due to its large sample size. Over 91,000 cases were examined, making it the largest dataset on BRAF testing in melanoma to date.

SPEAKER_00 0:43

Absolutely, Sam. What's striking are the disparities uncovered in BRAF testing across different regions in England, thus exposing significant healthcare inequalities. Moreover, during this five-year period, only around half of stage 3 and 4 tumours were tested for BRAF mutations.

SPEAKER_01 1:01

Indeed. And the BRAF mutation itself is a key driver in melanoma, influencing treatment decisions such as targeted therapy or immunotherapy. Without testing, patients risk missing timely and potentially life-saving treatments.

SPEAKER_00 1:16

That's right. Of tested melanomas, 34% were found to have BRAF mutations. The study revealed that women were less likely to be tested, even though women were more likely to carry these mutations.

SPEAKER_01 1:29

Yes, that's an interesting finding, which could be explained by selection bias for testing.

SPEAKER_00 1:34

Exactly. The survival data revealed five-year net survival for BRAF. Mutated melanomas was 55.9%, compared with 62.2% for BRAF wild types. Stage 2 cases with mutations had a lower survival, underscoring the need for consistent and early testing.

SPEAKER_01 1:53

This ties in with what we know that BRAF mutations predict poor outcomes unless treated with specific therapies. The study supports introducing BRAF testing into stage 2 melanoma care.

SPEAKER_00 2:04

It's a compelling point. The paper also reviewed testing methods over time, with most relying on PCR rather than next generation sequencing. The updated 2022 guidelines from the National Institute for Health and Care Excellence now advocate for immunohistochemistry as first-line testing, followed by PCR, which may help standardize approaches going forward.

SPEAKER_01 2:27

Before 2022, the lack of standardized guidelines likely contributed to regional inconsistencies, add the disruptions of the 2020 pandemic, and testing rates saw further decline. Still, this study's use of the National Disease Registration Service dataset gives us valuable information to address these gaps.

SPEAKER_00 2:47

Precisely. This raises questions for future inquiry. How do we ensure genetic testing is equitably available across patient demographics and regions? Another area of focus is treatment. The observation that first-line immunotherapy improves survival compared to targeted therapy in patients with BRAF mutations in this real-world dataset aligns with the data from recent clinical trials.

SPEAKER_01 3:12

Agreed. To sum up, ensuring consistent and equitable BRAF testing is an important public health priority. Not just to improve survival outcomes, but also to deliver fair and effective care for melanoma patients.

SPEAKER_00 3:24

Well put, Sam. And equally, monitoring B RAF mutations in stage 2 and beyond is key given their impact on survival. Clinicians and policymakers should explore introducing testing earlier in melanoma care.

SPEAKER_01 3:38

Lastly, while this study provides an excellent population level analysis, it also highlights gaps in molecular reporting and completeness of data. Bridging these could greatly advance our understanding of melanoma genetics and treatments.

SPEAKER_00 3:51

Exactly. That's all for today. Thank you for tuning in to BJD Talks.

SPEAKER_01 3:56

Indeed. Catch you next time, everyone. Stay curious.