A 65 year-old Asian male had a 1.65mm non-ulcerated acral lentiginous melanoma resected from the left foot in May 2011...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...The patient's therapy was switched to pembrolizumab2mg/kg 3-weekly in June 2014.After six weeks of treatment, he had declined symptomatically (to ECOG 2) and there was majorradiological disease progression with several new metastases and growth of all existing lesions (sum of diameters 459mm to 757mm, +65%)...