{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T14:00:55Z","timestamp":1789999255469,"version":"4.0.1"},"reference-count":45,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T00:00:00Z","timestamp":1789776000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Immune checkpoint inhibitors (ICIs) have transformed the therapeutic landscape of advanced melanoma, significantly improving long-term survival. Nevertheless, these therapies may induce immune-related cardiovascular adverse events, which are uncommon but potentially life-threatening. Myocarditis is the best-characterized and most severe manifestation, although a broad spectrum of cardiovascular complications\u2014including pericardial disease, arrhythmias, conduction abnormalities, heart failure, Takotsubo syndrome, and vascular events\u2014has increasingly been recognized. Emerging evidence suggests that melanoma itself and dual immune checkpoint blockade may confer a higher risk of cardiotoxicity than other malignancies or single-agent immunotherapy. This narrative review summarizes current evidence regarding the epidemiology, pathophysiological mechanisms, clinical presentation, diagnostic evaluation, cardiovascular surveillance, and management of ICI-associated cardiotoxicity in patients with melanoma. Diagnosis relies on integrating clinical findings with electrocardiography, cardiac biomarkers, echocardiography, cardiac magnetic resonance imaging, and, in selected cases, endomyocardial biopsy. Prompt interruption of ICI therapy, early administration of high-dose corticosteroids, and escalation to additional immunosuppressive therapies in refractory cases remain the cornerstone of treatment. As the use of ICIs continues to expand, improving cardiovascular risk stratification and implementing evidence-based surveillance strategies will become increasingly important. A multidisciplinary cardio-oncology approach is essential to ensure early diagnosis, optimize cardiovascular outcomes, and preserve the anticancer efficacy of immunotherapy.<\/jats:p>","DOI":"10.3390\/cancers18183041","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T12:50:03Z","timestamp":1789995003000},"page":"3041","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Immune Checkpoint Inhibitor-Associated Cardiovascular Toxicity in Melanoma: Current Evidence and Practical Clinical Management"],"prefix":"10.3390","volume":"18","author":[{"given":"Andrea","family":"Bottardi","sequence":"first","affiliation":[{"name":"Department of Cardiology, Clinique Saint George, 2 Avenue de Rimiez, 06105 Nice, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-8391-6323","authenticated-orcid":false,"given":"Gabriele","family":"Busin","sequence":"additional","affiliation":[{"name":"School of Medicine and Surgery, Center for Medical Sciences (CISMed), University of Trento, 38122 Trento, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9831-7959","authenticated-orcid":false,"given":"Lam","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, Sapienza University of Rome, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2862-8014","authenticated-orcid":false,"given":"Paolo","family":"Del Fiore","sequence":"additional","affiliation":[{"name":"Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, 35128 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgia","family":"Alberti","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Verona, 37134 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Danese","sequence":"additional","affiliation":[{"name":"Unit of Dermatology, Department of Integrated Medical and General Activity, University of Verona, 37134 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Nori","sequence":"additional","affiliation":[{"name":"Unit\u00e0 Operativa Complessa (UOC) Cardiologia, Ospedale di Arzignano\u2013Montecchio, AULSS 8 Berica, 36071 Arzignano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raimondo","family":"Pittorru","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy"},{"name":"PhD Program in Translational Specialized Medicine \u201cG.B. Morgagni\u201d, Curriculum in Cardiovascular Sciences, University of Padua, 35128 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5014-1122","authenticated-orcid":false,"given":"Fortunato","family":"Cassalia","sequence":"additional","affiliation":[{"name":"Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, 35128 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e447","DOI":"10.1016\/S1470-2045(18)30457-1","article-title":"Immune Checkpoint Inhibitors and Cardiovascular Toxicity","volume":"19","author":"Lyon","year":"2018","journal-title":"Lancet Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1001\/jamaoncol.2025.4543","article-title":"Immune Checkpoint Inhibitor-Associated Cardiovascular Toxic Effects: International Cardio-Oncology Society Position Statement","volume":"12","author":"Herrmann","year":"2026","journal-title":"JAMA Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1014","DOI":"10.1093\/eurheartj\/ehaf682","article-title":"Incidence and Risk Factors of Immune Checkpoint Inhibitor Myocardial and Muscle Toxicity: A French Nationwide Study","volume":"47","author":"Salem","year":"2026","journal-title":"Eur. 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