skip to main content

Immunotherapy Skin irAEs — SCE Dermatology MCQ

Instant feedback + full explanation. One question, done properly.

HardDrug ReactionsImmunotherapy Skin irAEsSCE Dermatology

After three cycles of pembrolizumab, a melanoma patient develops a pruritic lichenoid eruption affecting 4% body surface area, without mucosal involvement, blistering or systemic features. What is the most proportionate initial plan?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Continue immunotherapy with potent topical corticosteroid treatment and close review

Explanation lettering: D = shown as A · A = shown as B · B = shown as C · C = shown as D

C is correct. A limited lichenoid eruption without mucosal, blistering or systemic involvement is a low-grade cutaneous immune-related adverse event. It can usually be managed with potent topical corticosteroids, emollients or antipruritic therapy while checkpoint treatment continues and the patient is reviewed for progression. Permanent cessation and systemic immunosuppression are reserved for severe or life-threatening disease. A favourable-response association does not justify withholding symptom treatment, and changing checkpoint class does not prevent immune toxicity.

Reference: BJD practical management of checkpoint-inhibitor skin toxicities: https://academic.oup.com/bjd/article/189/Supplement_1/i3/7333864