Table 1. Summary of individual patient case presentations.

Patient	Clinical History
1	A 60-year-old female found to have a nasal polyp consistent with malignant melanoma, first treated with subtotal resection and radiation therapy with disease control for 6 years, followed by local recurrence and regional and distant metastases, all of which were treated surgically or radiotherapy. She was then treated with ipilimumab and pembrolizumab. The hepatic metastases responded to treatment, but the patient developed local recurrence unresponsive to continued immunotherapy and eventually required reresection. The patient later developed distant metastases and succumbed to disease 135 months after diagnosis.
2	A 44-year-old male found to have sinonasal malignant melanoma after expelling a large piece of tissue from his nose. He was treated with a combined open and endoscopic resection but developed local recurrence and regional and distant metastases, so was started on ipilimumab and radiation therapy. This was followed by endoscopic gross-total resection at the primary site due to rapid disease progression in this region. He developed progression of disease and both primary and distant sites despite continued immunotherapy and succumbed to disease 16 months after diagnosis.
3	An 85-year-old female with worsening nasal congestion and bloody postnasal drip was found to have a nasal mass consistent with malignant melanoma. She was also found to have an adrenal metastasis. She was treated with pembrolizumab, which led to relative stability of the adrenal metastasis but progression at the primary site, so underwent endoscopic resection at the primary site. This was followed by adjuvant radiation therapy. The patient is currently doing well off immunotherapy without evidence of active disease 33 months after diagnosis.
4	A 70-year-old female found to have sinonasal malignant melanoma and multiple sites of distant metastases. The primary site was treated with surgical resection followed by ipilimumab. Though there was initially a partial response at both the primary and distant sites, there was later progression of disease at the primary site and so she underwent endoscopic resection. She later had progression of distant metastases despite multiple immunotherapy regimens and succumbed to disease 37 months after diagnosis.