Successful reintroduction and continuation of nivolumab in a patient with immune checkpoint inhibitor-induced bullous pemphigoid

Many advanced cancers, such as melanoma, evade the immune system by exploiting negative feedback mechanisms. Immune checkpoint inhibitor (ICI) therapy dramatically enhances immune surveillance and has revolutionized treatment of advanced melanoma. However, ICI therapy is also associated with multiple cutaneous adverse events. We describe a patient treated with ICI, nivolumab, for stage 3D melanoma who developed bullous pemphigoid (BP). The patient achieved control of BP with discontinuation of ICI and a combination of topical and systemic steroids. Reintroduction of ICI therapy led to relapse of BP, which was successfully managed with an increase in systemic steroids allowing for continuation of ICI therapy.