Tislelizumab-induced psoriasis in a patient with hepatocellular carcinoma: A case report

Immune checkpoint inhibitors (ICIs) are widely incorporated into first-line treatment regimens for advanced hepatocellular carcinoma (HCC). Nevertheless, the growing incidence of immune-related adverse events (irAEs), particularly dermatologic toxicities, poses a substantial challenge to the continuation of anticancer therapy. The present study describes a case of tislelizumab-associated psoriasis in a patient with hepatitis C virus (HCV)-related HCC, emphasizing the need for prompt recognition and individualized management. A 60-year-old man with stage IIIA HCC and chronic HCV infection developed progressively worsening erythematous plaques with scaling during the eighth cycle of tislelizumab plus bevacizumab. Histopathological examination of a skin biopsy supported a diagnosis of pustular psoriasis. A Naranjo Adverse Drug Reaction Probability Scale score of 7 suggested that tislelizumab was the probable causative agent. Because the patient had type 2 diabetes mellitus and declined systemic glucocorticoid treatment, tislelizumab was discontinued, and narrow-band ultraviolet B (NB-UVB) phototherapy was administered in combination with topical corticosteroids. The skin lesions markedly resolved with no recurrence during the 6-week follow-up period. To the best of our knowledge, this is the first report of NB-UVB phototherapy successfully treating ICI-induced psoriasis. This case underscores the need for close monitoring of cutaneous irAEs during ICI therapy and suggests that NB-UVB phototherapy may be an effective alternative to systemic corticosteroids for managing ICI-induced psoriasis, particularly in patients where preservation of antitumor immunity is desirable or systemic steroids are contraindicated. Regular multidisciplinary follow-up and individualized management of adverse events are essential for optimizing both oncological and dermatological outcomes.