Given the median number of mt/Mb, TMB-high lymph node metastases showed a higher frequency of ATM (13.3% vs 2.6%, p = 0.003) and NRAS (5.7% vs 0.9%, p = 0.04) mutations and more commonly manifested overexpression of PD-L1 (7.9% vs 0.9%, p = 0.014) [Fig. 5]. Here, NRAS is linked to metastatic malignant neoplasm in the lymph nodes.