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Step 3 Guided injections: Patients are trained to selfinject subcutaneously (small insulintype needle) or can receive injections inoffice

NF1 mutations are particularly common in desmoplastic melanomas, where they are detected in 93% of cases, compared with 20% in nondesmoplastic melanomas.48 However, the predictive value for response to treatment with MEK inhibitors of the presence of these mutations is subject to debate.49,50 In addition to melanoma, mutations in the neurofibromin gene have been detected sporadically in other cancers, such as brain tumors, breast cancer, ovarian cancer, and leukemias, and this is a promising line of research.51 Finally, it is important to note that the rate of mortality due to cancer in individuals with NF1 is somewhat higher in individuals under 50 years of age, with this increased rate driven mainly by breast cancer and JMML, but the rates of cancer compared with the general population even out above this age.52 Likewise, although the mean life expectancy is somewhat lower in patients with NF1 than in healthy individuals, the majority of NF1 patients live past 70 years of age

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doi: 10.1017/S095442241700004X 12

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parkeri at a MOI of 1, and BSO was replaced at 1 hpi