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irAE Vitiligo — SCE Medical Oncology MCQ

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HardImmunotherapy & Targeted TherapyirAE VitiligoSCE Medical Oncology

A patient receiving nivolumab for renal-cell carcinoma develops sharply demarcated depigmented patches without inflammation or other organ toxicity. Examination and Wood lamp support vitiligo. Which interpretation is most accurate?

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Correct answer: A — This is melanocyte-directed immune toxicity; isolated disease rarely requires stopping nivolumab, and its RCC prognostic value is uncertain

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

C is correct. PD-1 blockade can generate autoreactive T-cell responses against melanocytes and produce vitiligo-like depigmentation. In the absence of severe inflammation or another immune toxicity, it is generally managed with sun protection, camouflage or dermatological treatment rather than automatic checkpoint discontinuation. The association with response is best established in melanoma; it should not be presented as a validated positive prognostic marker in renal-cell carcinoma. A invents an occult melanoma. B would not cause focal vitiligo and adrenal failure more often causes hyperpigmentation. D describes different morphology and overtreats. E misattributes the mechanism.

Reference: Systematic review of checkpoint-inhibitor-associated vitiligo: https://pmc.ncbi.nlm.nih.gov/articles/PMC11664058/