Compared with the remaining cases (BRAF V600E mutation alone or BRAF wild type and TERT promoter wild type), the coexistence of BRAF V600E and TERT promoter mutation was associated with virtually all high-risk factors, such as older age (p<0.001), larger tumor(p = 0.025), lymph node metastasis(p = 0.040), and advanced TNM stage(p<0.001). This evidence concerns the gene TERT and metastatic malignant neoplasm in the lymph nodes.