Melanoma BRAF Status in England and Canada: Who Gets Tested and Why It Matters

Original Article: A national cohort study of melanoma BRAF status, testing patterns, patient and tumour characteristics, treatment and survival in England from 2016 to 2021

Key takeaway points from article:

Melanoma is an aggressive skin cancer in which mutations in the BRAF gene play a critical role in prognosis and treatment selection. BRAF mutation status predicts response to targeted therapy and informs immunotherapy strategies. However, inconsistent molecular testing may delay access to effective treatments. Using population-based cancer registry data from England, Mistry et al. conducted the largest national study to date examining BRAF testing patterns, patient and tumor characteristics associated with BRAF mutations, and survival outcomes by BRAF genotype.

This retrospective cohort study included 91,415 patients diagnosed with melanoma between 2016 and 2021, of whom 14% (13,138 patients) had a documented molecular BRAF test. The authors note that regional variation and low BRAF testing rates in patients with stage III/IV melanoma may be due to a lack of clear guidance on testing, regional demographic differences, or more selective testing, but they most likely reflect variation in BRAF testing methods and compliance in sending data between regional laboratories. Among successfully tested tumors, 34% harbored a BRAF mutation. Testing rates varied markedly by region, ranging from 23% in the West Midlands to 11% in Yorkshire and the Humber. Female patients and individuals over 80 years of age were significantly less likely to undergo BRAF testing.

BRAF mutations were more frequently observed in female patients, younger individuals, those with advanced-stage disease, and tumors located on the trunk. In contrast, older patients and those with noncutaneous melanoma were less likely to carry BRAF mutations. Importantly, patients with BRAF-mutated melanoma experienced worse five-year net survival compared with those with BRAF wild-type tumors (55.9% vs 66.5%), with the greatest survival difference observed in stage II disease. Reduced survival in patients with BRAF-mutated tumours was also supported in a systematic review by Ny et al., though they note the prognostic role of BRAF status in early-stage melanoma remains unclear. 

Collectively, these findings highlight substantial inequities in molecular testing and demonstrate the prognostic significance of BRAF mutations in melanoma. The authors note that the National Institute for Health and Care Excellence (NICE) recommendations for BRAF testing introduced in 2022 may help reduce variation in testing practices. However, achieving this will depend on consistent adherence to the guidance, routine auditing of testing practices, and regular updates to national recommendations. The study underscores the need for consistent, early, and equitable BRAF testing, particularly in earlier-stage disease, to guide treatment decisions, inform prognosis, and ensure equal access to targeted and immunotherapeutic therapies.

Canadian data reveal similar challenges and opportunities in access to timely BRAF testing. A 2025 retrospective study by Guerra Ordaz et al. from the McGill University Health Centre evaluated the implementation of reflex BRAF mutation testing in melanoma. Historically, BRAF results were often unavailable at the time of initial oncology consultation, contributing to delays in treatment initiation. 

Overall, approximately 75% of patients had BRAF results available at their first oncology visit during the study period. Following institutional adoption of reflex testing beginning in mid-2017, testing was increasingly performed in advance and results were available prior to oncology consultation. Patients with pre-consultation BRAF results were significantly more likely to receive appropriate targeted therapy compared with those whose results were delayed (59.4% vs 36.4%). By 2022, all BRAF tests at the institution were completed before the initial oncology visit. 

Despite these improvements, national access remains inconsistent. Survey data indicate that across Canada, BRAF mutation status is available at first oncology consultation in only approximately 40% of melanoma patients. Specific barriers to testing may vary across provinces, given differences in provincial healthcare systems and testing pathways. Together, these findings demonstrate that delayed or inconsistent BRAF testing is not unique to the United Kingdom and reinforce the need for standardized, reflex molecular testing pathways in Canada to support equitable access to precision melanoma care.

Publication Date: May 5, 2026

References:

Mistry K, Jeffrey P, Levell NJ, et al. A national cohort study of melanoma BRAF status, testing patterns, patient and tumour characteristics, treatment and survival in England from 2016 to 2021. Br J Dermatol. 2025;193(6):1146-1154. doi:10.1093/bjd/ljaf351

Ny  L, Hernberg  M, Nyakas  M  et al.  BRAF mutational status as a prognostic marker for survival in malignant melanoma: a systematic review and meta-analysis. Acta Oncol  2020; 59:833–44.

Guerra Ordaz DJ, Whitelaw S, Kaouache M, et al. Evaluating the Implementation and Impact of BRAF Reflex Mutation Testing in Melanoma, Lung, and Colorectal Cancers. J Cutan Med Surg. 2025;29(2):150-155. doi:10.1177/12034754241302821

Summary By: Miranda Branyiczky