Abstract
Background/Objectives: With the increasing use of immune checkpoint inhibitors (ICIs), their administration in pregnant patients is expected to become more frequent. Although immunotherapy has transformed melanoma treatment, its use during pregnancy remains complex and controversial. Methods: We present the case of a young female patient diagnosed with advanced melanoma in whom combination ICI therapy was initiated. Results: During maintenance nivolumab treatment, a routine staging CT scan revealed an incidental pregnancy. Immunotherapy was discontinued upon pregnancy detection. The pregnancy proceeded without significant complications related to melanoma or the immunotherapy. During follow-up, the patient remained in remission and delivered a healthy male infant at 38 weeks of gestation. Conclusions: The most frequently reported side effects of ICIs during in utero exposure include fetal growth restriction, premature delivery, fetal distress syndrome, and occasional congenital abnormalities such as hypothyroidism and hand malformations. While existing evidence highlights potential risks, isolated case reports-including the present case-demonstrate that favorable pregnancy and neonatal outcomes are possible with careful monitoring and multidisciplinary care. Given the limited literature on ICI use during pregnancy, our case adds meaningful clinical insights to the field and underscores the need for further research and data collection to establish definitive guidelines, with an emphasis on individualized risk assessment and multidisciplinary care.