Dermatologic toxicity is ranked among the most frequent (40%-50%) and earliest reported (2-3 weeks) irAEs and includes rash, vitiligo (loss of skin pigment) and pruritus (itchy skin). Rashes are usually mild to moderate in nature and can be associated with itching. While rare, severe skin toxicities do occur and can be life-threatening including edema, oozing and separation of the dermis. Consultation with a dermatologist is highly recommended when severe skin toxicities with blistering or bullous lesions develop. As is often seen with irAEs, combination immunotherapy increases the risk for dermatologic toxicity. Interestingly, not all dermatologic toxicities are toxic in nature. Vitiligo is most common in melanoma patients and has been associated with survival benefit. Clinical assessment includes a total body skin exam, review of prior dermatologic disorders, serum testing and potential skin biopsy. Immunotherapy can continue in low grade dermatologic irAEs (ie, mild rash), but is often discontinued with persistent and/or high grade (> 3) dermatologic irAEs.
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