The use of customized gene mutation panels in NGS of ctDNA can produce significantly lower levels of mutation detection [22], and these panels typically monitor common melanoma driver mutations in BRAF, NRAS and KIT, along with mutations in tumor suppressor genes, such as TP53. However, such gene panels do not include many established mutations associated with treatment resistance and do not allow for the discovery and tracking of novel resistance mutations [22]. This evidence concerns the gene NRAS and melanoma.