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We don’t routinely check our IIB pts or primary lesions, we will check the primary lesion if the tissue from nodes is QNS and there is no other source of sampling or if safety is an issue wtih a new issue in sampling.
Although primary tumors may possess BRAF mutations, they don’t always 100% of the time correlate to metastatic sites, so checking new advanced disease against a high risk primary result would be prudent. As Rajni mentioned a quick 24 hour turn around with tissue IHC for BRAF can be conducted while conducting a full genetic analysis, especially if the start of treatment is urgent. I agree Krista, we will be seeing more sampling in earlier high risk disease, thank you for sharing your routine practice.

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