In Reply We are grateful to Adler and colleagues for their interest in our published study.1 We do agree that our results do not rule out the role of tumor mutational profile in the lymphatic spread of melanoma. On the contrary, our data support their results that indicate the prognostic value of BRAF mutation for lymphatic spread of melanomas. In our series, BRAF mutation (hazard ratio [HR], 1.9; 95% CI, 1.2-3.2; P = .005) was associated with an increased risk of lymphatic spread in univariate analysis (see eTable 2 in the Supplement of the article)1; thus, the effect of the association is in the same direction as in the study by Adler et al.2 However, the association did not remain statistically significant after multivariate analysis. The association between BRAF and TERT promoter mutations and hematogenous spread remained statistically significant even after multivariate analysis, indicating that those mutations are greater risk factors for hematogenous spread than for lymphatic spread.
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Nagore E, Kumar R. Lymphatic and Hematogenous Dissemination in Patients With Primary Cutaneous Melanoma—Reply. JAMA Dermatol. Published online September 11, 2019. doi:10.1001/jamadermatol.2019.2329
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