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...Fotemustine was ceased and trametinib2mg daily was commenced. Despite the patient noticing a rapid improvement in fatigue...All lung metastases were stable, no new metastases were evident, but no metastases regressed.