Introduction:
Cutaneous immune-related adverse events (CAEs) affect up to half of patients with melanoma receiving immune checkpoint inhibitors (ICIs), with presentations ranging from mild pruritus to severe inflammatory dermatoses. Severe CAEs may prompt treatment interruption or cessation, while even low-grade toxicities can impair quality of life and contribute to patient-initiated treatment discontinuation. Although CAEs are frequently managed with systemic corticosteroids (SCs), their use has been associated with lower response rates and reduced progression-free survival.
Methods:
We conducted an 18-month retrospective review of referrals to an oncodermatology service at a tertiary hospital in Brisbane, Australia (March 2024–August 2025; follow-up to December 2025). Melanoma patients receiving systemic therapy who developed CAEs were included. Data collected included tumour stage, treatment regimen, CAE phenotype, severity, initial oncology diagnosis, dermatologic diagnosis, management, and clinical outcomes.
Results:
A total of 20 patients with advanced-stage melanoma were identified (median age 71 years, 25% female), the majority receiving PD-1–based therapies (85%, n =17). Common CAE phenotypes included lichenoid (30%, n=6), eczematous (20%, n=4), psoriasiform (20%, n=4), and pruritus (10%, n=2). Dermatology assessment refined or revised initial diagnoses in 40% of cases (n=8). Management was primarily steroid-sparing, including supportive management with emollients, soap-free cleansers, photoprotection and topical antipruritic (75%, n=15). Topical corticosteroids (70%, n=14) and antihistamines (50%, n=10) were frequently prescribed. Dupilumab, an IL-4Rα inhibitor, was used in one Grade 3 CAE with eczematous eruption, achieving complete resolution. Systemic corticosteroids were only required in two cases (10%), and at low doses. Overall, 85% of CAES were either completely (70%, n =15) or partially resolved (15%, n=3). No CAE-related dose modifications were required, and treatment interruption and cessation attributable to cutaneous toxicity were rare, with one case each (5%).
Discussion:
Specialist dermatology input improves diagnostic accuracy and enables steroid-sparing management of CAEs in melanoma patients receiving ICIs. Integration of oncodermatology into melanoma care pathways may optimise toxicity management while supporting treatment continuity.