Table 2.

Timeline of progression of acral necrosis since administration of PD-1 inhibitor

Timeline from Treatment	Clinical Progression
Day 0	1st dose of pembrolizumab (No symptoms)
At 25 weeks	Raynaud’s like symptoms (Patient started on nifedipine)
At 27 weeks	No resolution of Raynaud’s symptoms and persistence of cyanosis (Patient started on prednisone)
At 29 weeks	Development of dry gangrene at fingertips bilaterally
At 33 weeks	Extension of necrosis and development of ulceration. Patient still on pembrolizumab. Sympathectomy performed (patient still on nifedipine and glucocorticoids)
At 37 weeks	Tumor progression (pembrolizumab stopped). Extension of the necrosis stopped after week 37