Vitiligo is an acquired skin disorder clinically characterized by depigmented macules and patches caused by the autoimmune destruction of melanocytes. Tofacitinib, an oral Janus Kinase (JAK) 1/3 inhibitor approved for the treatment of rheumatoid arthritis has been used off-label for alopecia areata, and more recently, vitiligo. With advancements in understanding vitiligo pathogenesis, JAK inhibitors like tofacitinib have emerged as a promising treatment modality especially when traditional therapies including topical steroids and calcineurin inhibitors have had minimal efficacy. As with other targeted therapies, tofacitinib is associated with certain adverse effects, the most dangerous being malignancy. We report a 61-year-old woman with a history of progressive vitiligo, refractory to multiple topical therapies, who was initiated on tofacitinib and showed significant improvement in disease. However, she subsequently developed a primary lung adenocarcinoma within 20 months of treatment and was forced to discontinue treatment. Although definitive causation cannot be established in this case without additional studies, it is important to note that tofacitinib, and other targeted therapies, have the ability to increase susceptibility to cancer. Unlike previous studies which report a relapse in vitiligo after treatment discontinuation, our case was noteworthy in that even after 5 months of discontinuing tofacitinib the patient maintained pigmentation. This finding offers a foundation for exploring new treatment protocols for patients whose vitiligo has clinically improved and who may not need continued usage of tofacitinib.