Deep learning techniques in predicting BRAF mutation status in cutaneous melanoma from histopathologic images

Aims To develop and validate a deep learning framework for discriminating BRAF mutation status in cutaneous melanoma from routine H&E whole-slide images (WSIs) as a proof-of-concept complementary approach alongside molecular testing. Methods We built a two-stage pipeline comprising U-Net–based tumour segmentation followed by an Inception v3 classifier. In total, 272 institutional melanoma cases with confirmed BRAF status were used for model development (training and internal validation). Generalisability was assessed in an external test set of 76 cutaneous melanoma cases from the Cancer Genome Atlas (TCGA). Dermatopathologist-defined tumour-rich regions of interest were used to train and evaluate segmentation. WSIs were processed at 20×magnification using 512×512 tiles; slide-level mutation probabilities were obtained by averaging the predicted probabilities across all tumour-enriched tiles. Results Inception v3 achieved area under the receiver operating characteristic curve values of 0.973 (training), 0.954 (validation) and 0.915 (TCGA testing) and outperformed a ResNet50 baseline, showing stable external generalisation. Performance remained robust in advanced pathological T-category primary tumours (pT3–T4). Tumour probability heatmaps supported spatial interpretability by localising regions contributing most strongly to predicted mutation status. Conclusions Deep learning applied to routine H&E WSIs can infer BRAF mutation status in cutaneous melanoma with consistent performance across institutional and external cohorts. Given the observed external sensitivity and negative predictive value, the model is not suitable for rule-out use or for deferring/omitting molecular testing. Any workflow integration is future work and would require prospective validation and calibration of probability outputs in real-world clinical series.