Bilateral Vitiligo-Like Depigmentation of Choroid and Retinal Pigment Epithelium Associated with Ipilimumab-Nivolumab Therapy for Metastatic Cutaneous Melanoma

Abstract Introduction: Ipilimumab and nivolumab are checkpoint inhibitors that are known to cause a multitude of inflammatory ocular adverse events. Here we report a patient with poliosis and symptomatic depigmentation of the choroid and retinal pigment epithelium (RPE) associated with checkpoint in...

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Published in:Case reports in oncology 2024-01, Vol.17 (1), p.122-127
Main Authors: Cotton, Caroline C., Chandrabhatla, Anirudha S., Higgins, Mackenzie L., Shildkrot, Yevgeniy
Format: Article
Language:English
Subjects:
Case Report
Case reports
checkpoint inhibitors
choroidal vitiligo
Combination therapy
Immunotherapy
Medical imaging
Medical prognosis
Melanoma
Metastasis
Monoclonal antibodies
Nervous system
oncology
Patients
Skin cancer
systemic therapy
Toxicity
Visual acuity
Vitiligo
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Summary:Abstract Introduction: Ipilimumab and nivolumab are checkpoint inhibitors that are known to cause a multitude of inflammatory ocular adverse events. Here we report a patient with poliosis and symptomatic depigmentation of the choroid and retinal pigment epithelium (RPE) associated with checkpoint inhibitor therapy for cutaneous melanoma. Case Presentation: The patient presented with floaters in both eyes and concerns for intraocular metastases of metastatic cutaneous melanoma after 1 month of therapy with ipilimumab and nivolumab. External examination revealed poliosis of her eyebrows and eyelashes. Fundus photography demonstrated multiple 1–3 disc-diameter hypopigmented placoid flat areas in the RPE/choroid exposing underlying choroidal vessels in both eyes. At subsequent evaluation 7 months later (after an additional 6 months of checkpoint inhibitor therapy), the lesions appeared more blanched. Evaluation nearly 20 months after the initial presentation showed no significant changes from her prior visit despite cessation of checkpoint inhibitor therapy for 13 months. Conclusion: Checkpoint inhibitor therapy for cutaneous melanoma metastases can cause depigmentation of the choroid and RPE that must be differentiated from progression of intraocular melanoma.
ISSN:1662-6575
1662-6575
DOI:10.1159/000535745