How do you manage new-onset vitiligo in a patient on immune checkpoint inhibitors?

Vitiligo is quite often (not always) associated with good long-term clinical outcomes for melanoma patients treated with immune checkpoint therapy. It is an indication of the activity of the drug, as it is due to unleashing of the T-cells’ attack on the bystander melanocytes in addition to melanoma cells, due to the presence of shared melanocytic antigens (e.g., MART-1, gp100, tyrosinase, etc). This side effect is not life-threatening even if the skin areas involved are extensive. There is no re...

I refer to dermatology. There is really not much that can be done. Vitiligo usually stays and may resolve very slowly. The patient needs extensive education on sun protection. The decision to continue depends on the risk-benefit ratio and the discussion with the patient. For example, if this is a lower-risk melanoma receiving adjuvant treatment, then we discuss with the patient. On the other hand, if it is metastatic disease, then we usually would continue.

I refer to dermatology when the vitiligo is extensive, causes discomfort due to the site of involvement (face), or is associated with significant pruritus. It is worth noting that topical ruxolitinib was recently FDA-approved for vitiligo treatment. Rosmarin et al., PMID 36260792

The utility (efficacy and safety) of topical ruxolitinib in melanoma patients with vitiligo is unknown. Preclinical work shows efficacy in an adoptive transfer mouse model of vitiligo, Parker et al., Journal of Investiga...