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Melanoma on Immunosuppression — RACP Adult Medicine MCQ

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HardGeneral Internal MedicineMelanoma on ImmunosuppressionRACP Adult Medicine

A 45-year-old man with IBD on infliximab and azathioprine develops melanoma (Breslow 1.8 mm). After WLE and negative SLNB, what immunosuppression change?

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Correct answer: B — Cease azathioprine; consider switching to vedolizumab (gut-selective)

Cease thiopurine (highest skin cancer risk). Consider gut-selective vedolizumab to reduce systemic immunosuppression while maintaining IBD control.

Reference: eTG – 2025; Cancer Council Australia – 2020; ECCO – 2024