{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:36:13Z","timestamp":1787016973953,"version":"build-2736575974"},"reference-count":13,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,8,6]]},"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:p>Mucosal melanoma is a rare subtype of melanoma and represents a unique diagnosis and treatment challenge. Immune-checkpoint inhibitors (ICIs) have revolutionised metastatic melanoma treatment, and one of the leading regimens is the combination of ipilimumab (anti-cytotoxic T lymphocyte-associated antigen 4: CTLA4) and nivolumab (anti-programmed cell death protein 1: PD1). We report a case of a patient with metastatic mucosal melanoma treated with ipilimumab and nivolumab who developed multiple immune-related adverse events (irAEs) including uveitis, type I diabetes complicated by diabetic ketoacidosis, destructive thyroiditis, hepatitis and vitiligo. Endocrinopathies including type 1 diabetes and hypothyroidism were treated with insulin and levothyroxine. Hepatitis was responsive to steroids. She had sustained complete response 12 months after discontinuation of the combination therapy. With the wide usage of ICIs in multiple types of malignancies, it is important for general practioners to recognise common and serious irAEs due to ICIs.<\/jats:p>","DOI":"10.1136\/bcr-2021-243713","type":"journal-article","created":{"date-parts":[[2021,8,20]],"date-time":"2021-08-20T12:16:55Z","timestamp":1629461815000},"page":"e243713","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Ipilimumab and nivolumab induced immune-related adverse events in metastatic mucosal melanoma"],"prefix":"10.1136","volume":"14","author":[{"given":"Yenong","family":"Cao","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7594-1639","authenticated-orcid":false,"given":"Muhammad Zubair","family":"Afzal","sequence":"additional","affiliation":[{"name":"Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keisuke","family":"Shirai","sequence":"additional","affiliation":[{"name":"Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,8,20]]},"reference":[{"key":"2025082802140134000_14.8.e243713.1","doi-asserted-by":"crossref","DOI":"10.1007\/s11912-018-0675-0","article-title":"Mucosal melanoma: a literature review","volume":"20","author":"Yde","year":"2018","journal-title":"Curr Oncol Rep"},{"key":"2025082802140134000_14.8.e243713.2","first-page":"e23","article-title":"Mucosal melanoma: new insights and therapeutic options for a unique and aggressive 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immune-related adverse events associated with immune checkpoint inhibitors for treatment of non-small cell lung cancer","volume":"6","author":"Shankar","year":"2020","journal-title":"JAMA Oncol"},{"key":"2025082802140134000_14.8.e243713.12","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1016\/j.jaad.2019.06.035","article-title":"Survival and prognosis of individuals receiving programmed cell death 1 inhibitor with and without immunologic cutaneous adverse events","volume":"82","author":"Chan","year":"2020","journal-title":"J Am Acad Dermatol"},{"key":"2025082802140134000_14.8.e243713.13","doi-asserted-by":"crossref","DOI":"10.3390\/cancers12030738","article-title":"Review of indications of FDA-approved immune checkpoint inhibitors per NCCN guidelines with the level of evidence","volume":"12","author":"Vaddepally","year":"2020","journal-title":"Cancers"}],"container-title":["BMJ Case 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