Supplementary Material for: Combining surgery, radiotherapy and topical chemotherapy to prevent primary orbital exenteration for atypical caruncular melanoma: a case report

Introduction
This case report demonstrates the possibility of successful eye and vision-sparing therapy for caruncular melanoma.

Case presentation
We present an atypical presentation of a caruncular melanoma. After excisional biopsy, residual flat conjunctival melanosis resolved using topical chemotherapy (5-fluorouracil), which was well tolerated. Relapse of the melanoma was treated with external beam radiotherapy, but the tumor grew despite treatment. Eighteen months after complete excision of the relapsed melanoma, the patient remains tumor-free while the eye and its function remain preserved.

Conclusion
This case report suggests that aggressive eye-sparing therapy for caruncular melanoma combining surgery, adjuvant topical chemotherapy and external beam radiotherapy, can be an alternative for primary orbital exenteration.