CTLA4 and Abnormality of the skin: Despite 2 further cycles of combined anti-PD1 (nivolumab 1 mg/kg) and anti-CTLA4 (ipilimumab 3 mg/kg) immunotherapy 3 weeks apart, followed by 1.5 cycles of Fotemustine, the patient died 22 months after the development of the scleroderma-like skin changes.