Impact of Reflex Testing for BRAF Mutational Status in Advanced Melanoma

The use of targeted therapy in patients with advanced, BRAF-mutated melanomas has necessitated timely access to BRAF mutational status in order for clinicians to proceed with treatment decisions.

To assess the impact of pathologist-initiated reflex BRAF testing in patients with advanced melanoma on laboratory turnaround time and time to systemic treatment.

At our tertiary care center and 3 affiliated community hospitals, we implemented a guideline for pathologist-initiated reflex testing for BRAF mutational status in patients diagnosed with melanoma and positive lymph nodes or new diagnosis of a metastatic site. Retrospective review was performed for 65 cases of advanced melanoma for which BRAF testing was ordered, during a period inclusive of 6 months before and after guideline implementation.

Implementation of reflex testing guidelines did not significantly affect the overall number of BRAF tests ordered for patients with melanoma. In cases with reflex testing compared to routine testing, total turnaround time was reduced by from 52.5 ± 5.6 to 18.6 ± 1.0 days (P < .001). In patients who received systemic therapy, without intentional delay by interval completion lymph node dissection (CLND), the use of reflex BRAF testing reduced time to systematic treatment from 71.7 ± 11.4 to 37.7 ± 4.6 days (P = .02). Time to systematic treatment was unchanged in those who underwent interval CLND (118.9 ± 10.9 versus 110.5 ± 22.5; P = .75).

These data support a recommendation for pathologist-initiated reflex testing of BRAF mutational status in advanced melanoma as a standard practice in pathology laboratories.