Unusual Timeline of Nivolumab-induced Vitiligo in a Patient with Melanoma

Vitiligo, manifested by skin hypopigmentation, is an autoimmune disorder of the skin due to the autoimmune destruction of melanocytes. Nivolumab, which is a programmed cell death–1 receptor inhibitor, is a well-known therapy for melanoma. Nivolumab-induced vitiligo has been described in literature, explained by destruction of non-cancerous melanocytes. This is considered a favorable response, due to a correlated stronger immune response against tumor cells. The average onset of the vitiligo is reported to be 5.2 months after starting the therapy, with a maximum reported onset being 9 months. We present a 52-year-old male patient whose initial vitiligo presentation occurred a year after starting the therapy and has continued for months after concluding Nivolumab therapy.