BI26 Treatment-induced scleroderma in a patient with metastatic melanoma

Abstract We present a 71-year-old woman who presented with sclerodermoid plaques affecting the abdomen and lower limbs, following single cycle of nivolumab ipilimumab 20 months prior for BRAF-mutant metastatic melanoma (pulmonary hepatic metastases). Immunotherapy was discontinued owing to iatrogenic colitis, confirmed on flexible sigmoidoscopy, requiring oral prednisolone, infliximab and, later, modified-release beclomethasone dipropionate. Owing progression disease, she commenced targeted therapy dabrafenib trametinib. A lesional punch biopsy performed; histological analysis demonstrated dense dermis mild chronic inflammatory infiltrate, in keeping diagnosis scleroderma. Treatment combination topical corticosteroids vitamin D analogues improved disease from 15% body surface area (BSA) 3% after 4 months. performed literature search PubMed articles immunotherapy-related scleroderma published up August 2022 identified 18 that met our inclusion criteria. Scleroderma reported patients melanoma, non-small-cell lung cancer, renal cell carcinoma, rectal adenocarcinoma, adenocarcinoma large-cell neuroendocrine cancer treated pembrolizumab, nivolumab, atezolizumab ipilimumab. Latency onset ranged 0 months, treatment included systemic corticosteroids, mycophenolate mofetil, hydroxychloroquine, cyclophosphamide, immunoglobulins, varying outcomes. There no clear relationship between subtype, duration response treatment. Furthermore, lack documented quantitative or semiquantitative measurements improvement such as BSA modified Rodnan skin score is limiting. Our case report important promoting awareness localized rare side-effect immunotherapy highlights various options available.