Immunotherapy‐Related Cutaneous Toxicities in Melanoma: A Dermoscopic Perspective

ABSTRACT Cutaneous toxicities associated with immune checkpoint inhibitor therapy in patients treated for melanoma are usually among the first and most common immune‐related complications. The pathophysiology underlying immune checkpoint inhibitors–induced cutaneous toxicities remains incompletely understood. Interestingly, the occurrence of specific skin toxicities has been correlated with improved survival and enhanced tumour response, suggesting a potential biomarker role for these adverse events in predicting treatment efficacy. The latest findings highlight the importance of integrating clinical, genetic, immunological and histopathological risk factors to optimise the stratification of toxicity for personalised immune checkpoint inhibitor therapy. Currently, immunotherapy‐related skin toxicities are mostly diagnosed based on clinical presentation, in correlation with histopathological examination in certain atypical cases. Dermoscopic images of cutaneous side effects that have been published so far are similar to those described in classical dermatological entities. This is also consistent with our observations of dermoscopic features in patients treated for melanoma in our daily practice. The purpose of this paper is to present a summary of the dermoscopic features seen among selected cutaneous toxicities associated with immune checkpoint inhibitor therapy, based on a review of own cases, iconography and literature publications. The authors wish to emphasise the potential of dermoscopy as a useful tool for rapid preliminary assessment and as a valuable complement to clinical examination, as well as to the qualification process for histopathological evaluation. Furthermore, it enables the rapid implementation of appropriate therapy, thereby reducing the risk of treatment discontinuation/termination.