PMC9881409_01
Patient 1: (A) Gastric cancer pathology (adenocarcinoma HEx10). (B) Vitiligo-like depigmentation of the skin on the face and neck. (C) Vitiligo-like depigmentation of the skin on both upper limbs. (D) Vitiligo-like depigmentation of the face under the Wood's lamp. (E) Vitiligo-like depigmentation of the right hand under the Wood's lamp. (F) Biopsy pathological immunohistochemistry of vitiligo-like depigmentation (melan-A+).
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Cardio adenocarcinoma was identified by pathology ( Figure 1A ), and the immunohistochemistry results were as follows: HER-2 (0); Ki-67, approximately 50% (+); CgA (-); CD56 (-); and Syn (-). The scope gradually widened, and some of the depigmented lesions merged ( Figures 1B   , C ). Wood's lamp examination confirmed depigmentation of the patches ( Figures 1D   , E ). Immunohistochemistry revealed a decrease in melanocytes, and S-100 (+), HMB45 (+), melan-A (+), and approximately 20% Ki-67 (+) ( Figure 1F ).
PMC9881409_02
Patient 2: (A) Pathology of lung cancer (adenocarcinoma HEx4). (B) Photographs of a patient who was diagnosed with vitiligo. (C) Photographs of the patient prior to treatment. (D) Approximately 2 weeks after the initial treatment, vitiligo-like depigmentation emerged on the skin of the patient's head and newborn hair. (E) Approximately 2 weeks after the initial immunotherapy, vitiligo-like depigmentation began to show on the skin of the patient's right forearm, comparison to skin tone of the wrist. (F) Depigmentation of eyelashes following 12 immunotherapies. (G) Significant depigmentation of the skin on the right forearm after the 12 immunotherapies, which gradually fused into fragments and vitiligo-like depigmentation of the skin on the entire arm. (H) A side view of the patient following 12 immunotherapies.
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The pathological and immunohistochemical findings supported the diagnosis of adenocarcinoma ( Figure 2A ). The patient's vitiligo was diagnosed in February 2014, and the lesions were on the left wrist (3 cm x 3 cm), forehead (15 cm x 4 cm), and the neck skin ( Figures 2B   , C ). Approximately 2 weeks after the first immunotherapy, the original vitiligo focus gradually expanded, and new vitiligo-like depigmentation appeared on the skin of the top of the head ( Figure 2D ), as well as on the skin of the limbs ( Figure 2E ), which fused into pieces. Thus far, 12 immunotherapies have been administered to the patient, and the depigmentation range has been expanded to include the hair and entire skin of the body ( Figures 2F   -H ).
PMC9881409_03
Patient 3: (A) Pathology of lung cancer (squamous cell carcinoma HEx10). (B) Immunohistochemistry of lung cancer: P40 (+). (C) Immunohistochemistry of lung cancer: P63 (+). (D) After 12 immunotherapies, the patient's forehead had vitiligo-like depigmentation and was fused into pieces. (E) and (F) After 12 immunotherapies, the patient's hands had vitiligo-like depigmentation.
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The third patient was a 79-year-old woman who was diagnosed with squamous cell carcinoma ( Figure 3A ). Syn (-) ( Figures 3B   , C ). Six sessions of taxol and carboplatin were administered from November to February 2021. Immunotherapy caused the dispersed depigmentation sites to fuse into a group and the range gradually widened ( Figures 3D   -F ), causing depigmentation of a significant proportion of the skin on the waist and belly, resembling vitiligo.