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Sarcoidosis-like irAE — SCE Medical Oncology MCQ

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HardMelanoma & SkinSarcoidosis-like irAESCE Medical Oncology

A 60-year-old man with metastatic melanoma on nivolumab develops sarcoidosis-like granulomatous reaction with bilateral hilar lymphadenopathy and skin nodules. Biopsy of a skin nodule shows non-caseating granulomas. What is the clinical significance?

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Correct answer: E — Sarcoidosis-like irAE — can mimic metastatic disease on imaging; biopsy distinguishes granuloma from tumour

Sarcoidosis-like granulomatous reactions are a recognised irAE (~5-7% on imaging) that can closely mimic metastatic disease (especially mediastinal/hilar lymphadenopathy on CT/PET). Biopsy showing non-caseating granulomas without malignant cells confirms the diagnosis. This is important to prevent misclassification as progression and premature treatment change. Management depends on symptoms: asymptomatic cases can be observed; symptomatic cases may require corticosteroids. ICI can often be continued.

Reference: ESMO 2024 irAE Management Guidelines; Chopra et al Cancer 2018