Introduction:
Immune checkpoint inhibitors are revolutionising treatment of metastatic melanoma, including both Ipilimumab and Pembrolizumab. Bullous pemphigoid is an uncommon but noteworthy immune-related adverse event associated with immune checkpoint inhibitors in metastatic melanoma treatment.
Methods:
We report two cases of bullous pemphigoid associated with immune checkpoint inhibitors, the clinical findings, and dermatological management.
Findings:
Case 1 is a 78-year-old male with metastatic melanoma treated successfully with pembrolizumab, while Case 2 is a 79-year-old male with metastatic melanoma treated with ipilimumab and nivolumab.
Both patients developed widespread bullous pemphigoid, confirmed on histopathology and direct immunofluorescence.
Both patients have been successfully managed with a combination of topical steroids and oral mycophenolate. Both patients remain in remission from the metastatic melanoma.
Conclusion:
This case report discusses bullous pemphigoid as a serious and rare complication of immune checkpoint inhibitor immunotherapy for metastatic melanoma. Clinicians should maintain vigilant for dermatologic manifestations in patients receiving immune checkpoint inhibitors and consider bullous pemphigoid in the differential diagnosis for dermatological manifestations. Prompt diagnosis and appropriate management are crucial to optimise patient outcomes and minimise treatment interruptions.