Cutaneous melanoma, pT1a, St. IV (AJCC 2017)
03/2012 superficial spreading melanoma of the shoulder, BRAF wildtype, Breslow 0,7 mm
04/2014 axillary lymph node metastases with vascular compression
08/2014 pulmonal metastases
04-07/14 radiochemotherapy (carboplatin/paclitaxel)
08-09/2014 immunotherapy with ipilimumab (2 cycles, progressive disease)
10/14-01/16 immunotherapy with pembrolizumab (20 cycles)
Four weaks after initiation of the immunotherapy (IT) with pembrolizumab the patient presented with shortness of breath due to irPneumonitis CTCAE grade 2. After high-dose systemic corticosteroid therapy and improvement of symptoms the immunotherapy could be continued. Within fourteen months after initiation of the therapy the patient showed painful oral mucosal erosions. Biopsy was taken and showed a typical histologic picture of lichen planus.
Systemic retinoids and local therapy with triamcinolone acetonide adhesive paste constantly led to clinical improvement and complete healing.
We discontinued the immunotherapy due to complete response.
The skin is one of the most common manifestations of immune-related adverse events and may occur in up to 30 to 50% of patients being treated with Checkpoint-Inhibitors (Lacouture M et al., Am J Clin Dermatol. 2018). They are typically mild and can often be treated without interruption of immunotherapy. However, there are also potentially life-threatening cutaneous irAEs such as Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN), which are treated with permanent ICI discontinuation (IW Tattersall, Leventhal JS, Yale J Biol Med. 2020). Interestingly, cutaneous irAEs, especially such as vitiligo, have been shown to be a positive prognostic indicator for the treatment, especially in melanoma patients (Quaglino P. et al., Ann. Oncol. 2010).
