Granuloma Annulare in the Setting of Ipilimumab Therapy

A 29-year-old Caucasian man presented to an outside clinic with an erythematous, exophytic, eroded tumor on his right heel; a biopsy showed acral lentiginous malignant melanoma, with a Breslow depth of 2.01 mm, ulceration, and one dermal mitosis per square millimeter. He underwent wide local excision with 3 cm margins as well as right popliteal and right inguinal sentinel lymph node biopsies, which revealed one popliteal lymph node and two right inguinal lymph nodes with metastatic melanoma. Subsequently, a completion lymph node dissection was performed, which was negative. He was enrolled in a clinical trial for his stage IIIB melanoma evaluating adjuvant interferon vs. ipilimumab and was randomized to the low-dose ipilimumab arm. He received an induction dose of 3 mg/kg every three weeks for a total of four doses, followed by maintenance dosing of 3 mg/kg every twelve weeks for a total of four doses.