A 65 year-old Asian male had a 1.65mm non-ulcerated acral lentiginous melanoma resected from the left foot in May 2011...and fotemustine was commenced in January 2014....By May 2014 disease had progressed in lung, nodal and soft tissue metastases, fatigue had increased (ECOG 2), and a KIAA1549-BRAF fusion was detected...Fotemustine was ceased and trametinib2mg daily was commenced.