A case of anhidrosis and widespread vitiligo-like depigmentation with metastatic melanoma immunotherapy

We present a case of a 37-year old male with widespread depigmentation and marked reduction in sweating on a background of metastatic melanoma on a clinical trial of Nivolumab vs Ipilimumab vs combination therapy. A concurrent adverse effect was thyroiditis treated with thyroxine. A thermal starch-iodine sweat test (oral temperature increased to 37.6 degrees for 60 minutes) confirmed widespread anhidrosis. Histopathology of axillary skin demonstrated a lymphocytic infiltration surrounding eccrine glands. The overlying epidermis was largely devoid of melanocytes, highlighted through Melan A staining. The patient has continued on the clinical trial and has no detectable metastasis on his most recent PET-CT. There has been no return of sweat production or pigmentation. This is the first case of anhidrosis on ipilimumab or nivolumab or combination therapy to date.

Dr. Ludi Ge