This patient received double immunotherapy, which remains a first-line standard of care in metastatic melanoma, but which also can induce a myriad of autoimmune toxicities, resulting in stopping therapy with the patient after just two doses [2]. The small molecule targeted anti-B-raf dabrafenib induced high levels of response and markedly improved survival in metastatic melanoma, but induced a marked increase in cutaneous squamous cell cancers, felt to be due to reflex MEK activation to decreased B-raf signaling. This evidence concerns the gene BRAF and metastatic melanoma.