Is it really vitiligo?

Vitiligo is a skin depigmentation disorder resulting from autoimmune destruction of melanocytes. This may occur spontaneously, in association with melanoma or as a result of immune checkpoint inhibitor (ICI) therapy. Development of vitiligo in the context of metastatic melanoma has been cited as evidence of enhanced anti-melanoma immunity. This is supported by studies that correlate vitiligo with prolonged progression-free and overall survival (1). Despite an abundance of publications speculating on this, few have defined diagnostic criteria for vitiligo and even fewer have recognised hypopigmentation as a separate entity. To highlight this we present the case of a 56-year-old man with acquired hypopigmentation after seven cycles of nivolumab therapy for metastatic melanoma. Despite having a clinical appearance of vitiligo, Wood’s lamp examination was negative. Biopsy revealed persistence of melanocytes in the epidermis. This case raises questions about reports of vitiligo in ICI therapy, and highlights the importance of clinicopathological correlation.
1. Nakamura Y, Tanaka R, Asami Y, Teramoto Y, Imamura T, Sato S, et al. Correlation between vitiligo occurrence and clinical benefit in advanced melanoma patients treated with nivolumab: A multi-institutional retrospective study. J Dermatol. 2016 Aug 11.

Ms Estella Janz-Robinson

ACT Health

Since graduating from the Australian National University in 2014, Dr Estella Janz-Robinson has been employed by ACT Health. This year she is working under the supervision of Dr Diana Rubel and Dr Andrew Miller in the capacity of part-time dermatology research registrar and unaccredited trainee at Canberra hospital, respectively. Estella has a keen interest in teaching, and over the last 10 years has worked as a laboratory demonstrator and casual lecturer for two universities, a personal tutor for the Indigenous Teaching Assistance Scheme, and a clinical group tutor for the Australian National University. She is also an active member of the Canberra Regional Medical Education Council, as a junior medical officer representative for both the accreditation and education committees.