Supplementary Material for: Cryotherapy after topical interferon alpha 2b to treat conjunctival primary acquired melanosis

When primary acquired melanosis (PAM) with atypia affects the tarsal conjunctiva, a radical surgery can be mutilating, requiring reconstructive surgery of the eyelid. Topical Chemoteraphy associated to local crioteraphy may be an alternative. A 64-year-old Caucasian female presented with diffuse PAM of the right eye involving the inferior tarsal conjunctiva, fornix, and inferotemporal bulbar conjunctiva. Histological study showed a PAM with atypia (C-MIN 5). Given the extent of the lesion and its location, a wide mutilating excision was ruled out. Topical Interferon alpha 2b (IFN-α2b) treatment (1,000,000 IU/mL, 4 times a day) was administered during 10 weeks. However the regression was very slow. Then local cryotherapy was proposed (8s at –80ºC per aplication) to the entire pigmented lesion. This afforded progressive depigmentation, which was complete 2 months later. No recurrence of the lesion has been noted during 3 years of follow-up. The combination of the two procedures reduces IFN-α2b eyedrop administration time, enhancing patient compliance. The combination eradicated the tumour without compromising ocular cosmesis.