Immune Checkpoint Inhibitor-Associated Cardiovascular Toxicity in Melanoma: Current Evidence and Practical Clinical Management

Abstract

Simple Summary Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of advanced melanoma, leading to substantial and durable improvements in patient survival. However, these agents may also trigger immune-related cardiovascular toxicities, which, although uncommon, can be severe and potentially fatal. Myocarditis is the most feared complication because of its rapid onset and high mortality, particularly in patients receiving combination immunotherapy. Other manifestations include pericardial disease, arrhythmias, conduction disorders, heart failure, Takotsubo syndrome, and vascular complications. Early recognition, appropriate cardiovascular surveillance, and prompt multidisciplinary management are essential to improve clinical outcomes while preserving the benefits of anticancer treatment. This narrative review summarizes current evidence on the epidemiology, pathophysiology, diagnosis, surveillance, and management of ICI-associated cardiotoxicity in melanoma, providing a practical overview for oncologists, cardiologists, dermatologists, and other clinicians involved in the care of melanoma patients.