Hypermethylation serves as an alternative mechanism for the genetic silencing of MLH1. In CRC, it has been documented that dMMR/MSI-H is induced by hypermethylation of the MLH1 promoter region in over 75% of dMMR carcinomas, while germline mutations associated with Lynch syndrome account for less than 25% (27). This evidence concerns the gene MLH1 and Lynch syndrome.