case_images: PMC10942793_01
case_images: Slit lamp photography of the left eye at presentation (a); 6 weeks after surgery, residual pigmentation (b); 8 months after surgery, complete resolution of residual pigmentation 5 months after adjuvant topical chemotherapy with 5-fluorouracil (5-FU) (c); 1.5 years after the second surgery, 22 months after external beam radiotherapy (EBRT) (d).
case_images: cop-2024-0015-0001-536590_F01.jpg
case_images: PMC10942793_01_cop-2024-0015-0001-536590_F01.jpg
case_images: F1
case_images: Slit lamp examination revealed a round, amelanotic, elevated lesion with yellow crustae and blood on the surface, arising from the caruncle of the left eye and measuring 5 x 4 mm (shown in Fig. 1a). Postoperatively, a small area of flat conjunctival melanosis was clinically noticed in the remnant of the caruncle (shown in Fig. 1b). Three months after completion of 3 cycles topical 5-FU 1% the flat conjunctival melanosis disappeared (shown in Fig. 1c). He only suffers a mild medial ectropion, but without any discomfort (shown in Fig. 1d).
case_images: First excisional biopsy showed staining for Melan-A with strong cytoplasmic staining of the atypical melanocytes, also in the in situ component at the surface (left) (magnification x40) (a); and anti-Ki-67 immunostaining demonstrating an increased proliferation of atypical melanocytes of more than 20% (magnification x20) (b). Biopsy showing atypical melanocytes with enlarged nuclei, varying in shape and size (hematoxylin and eosin, magnification x5 (c) and x40 (d)).
case_images: cop-2024-0015-0001-536590_F02.jpg
case_images: PMC10942793_01_cop-2024-0015-0001-536590_F02.jpg
case_images: F2
case_images: Immunohistochemical analysis demonstrated reactivity to Melan-A (shown in Fig. 2a) and SOX10. The Ki-67 proliferation index was high (>20%) (shown in Fig. 2b). The invasive component showed extension into the lateral and deep surgical margins, meaning no complete resection was achieved (shown in Fig. 2c, d).
case_images: MRI of the orbits showing the tumor inferonasally of the left eye (T2 weighted, no contrast, slice 11/19) (a); and the grown lesion despite EBRT 6 months later (T2 weighted, no contrast, slice 12/19) (b).
case_images: cop-2024-0015-0001-536590_F03.jpg
case_images: PMC10942793_01_cop-2024-0015-0001-536590_F03.jpg
case_images: F3
case_images: However, 13 months after surgery and 11 months after topical chemotherapy, MRI demonstrated a suspected relapse of the tumor inferonasally of the left eye with a diameter of 11 mm without muscle invasion (shown in Fig. 3a). Follow-up imaging 3 months after completion of radiotherapy revealed that the lesion had grown despite treatment (shown in Fig. 3b).