NRAS and acral lentiginous melanoma: However, one recent study of 178 Asian patients with advanced melanoma (40% with acral melanoma) who received treatment with immune checkpoint inhibitors suggested that NRAS mutations, TP53 mutations and NF2 deletions are associated with resistance to checkpoint inhibitors, whereas MYC and RPS6KB1 amplifications were observed more frequently in patients who responded to these treatments (59).