Grant McArthur, MBBS, BMedSci, PhD, FRACP, of the Peter MacCallum Cancer Centre, Melbourne, Australia, suggests next steps for poor prognosis BRAF-mutant melanoma patients with elevated lactate dehydrogenase (LDH). He highlights that he personally wants to see greater focus in understanding the biology behind the tumors in order to develop rational approaches. There is already one Phase III trial planned where anti-PD-1 will be added to BRAF and MEK inhibition in the subset of patients with poor prognosis. He suggests, however, that we still lack understanding of the biological drivers of poor outcomes are in patients with an elevated lactate dehydrogenase. Prof. McArthur proceeds to emphasize that we still do not know whether poor prognosis is related to the tumor metabolism or whether it is the result of the hypoxic microenvironment within these tumors, for example. He believes that once we fully understand the biology correlates behind the high lactate dehydrogenase, we would be able to make more rational approaches, which would in turn allow for better treatment of these patients. Finally, he suggests that further research and enrolment of patients into research studies where we can then proceed to conduct tissue biopsies and understand the clinical biology behind the disease. Recorded at the 2016 World Congress on Cancers of the Skin (WCCS) and the Congress of the European Association of Dermato-Oncology (EADO) in Vienna, Austria.