MLH1 and Lynch syndrome: BRAF (V600E) and/or MLH1 promoter hypermethylation testing may be performed on cases that have no IHC staining for MLH1, as a substantial portion of tumors that lack staining for the MLH1 protein have a somatic mutation in BRAF (V600E)or MLH1 promoter hypermethylation, neither of which is commonly associated with Lynch syndrome.  Patients who do not have the BRAF mutation or MLH1 promoter hypermethylation, or have neither, are then offered DNA analysis of the MLH1 gene [1], [2], [3].