A female in her 40 s with history of stage IA malignant melanoma of the right back presented with biopsy-proven recurrence in a right axillary lymph node over 1 year after her original diagnosis and definitive resection. After complete right axillary lymphadenectomy she was started on adjuvant nivolumab. The patient initially experienced mild and transient side effects including fatigue, headaches, grade 1 diarrhea, and grade 1 transaminitis that were managed conservatively. Seven months into adjuvant therapy, she present with generalized liposdytrophy, characterized by subcutaneous adipose redistribution and metabolic syndrome, including dyslipidemia and impaired glucose tolerance. Histological examination of biopsies revealed granulomatous, lobular panniculitis. This case underscores the potential for immune checkpoint inhibitors to induce generalized lipodystrophy, a rare but clinically impactful irAE. While the patient achieved longterm remission from melanoma, the unresolved lipodystrophy and associated metabolic changes highlight the need for further investigation into the mechanisms and management of long term irAEs.