The same researchers suggested that wide local excision and prophylactic, modified lymphadenectomy should be performed in patients with scrotal melanoma with a Breslow depth of 1 mm or greater, ulceration, or Clark level IV or V. The present authors could not start BRAF inhibitors in this patient because insurance policies only pay treatment costs for targeted therapies in distant metastatic disease. The gene discussed is BRAF; the disease is metastatic neoplasm.