When someone says they have a “freckle in the eye”, they are usually describing a naevus (a cluster of pigment cells), not an automatic cancer diagnosis. The word “freckle” is informal and can refer to pigment in different places, and location changes the risk and the follow-up plan.
Choroidal naevus sits inside the eye, under the retina, and is often found incidentally during a dilated retinal examination. Most are stable for life, but a small minority can transform into melanoma, which is why clinicians document objective risk features and monitor properly rather than guessing. ¹ ² Iris naevus appears on the coloured part of the eye; most remain unchanged, but some enlarge over years and a small subset behave like iris melanoma. Conjunctival naevus lies on the surface (the “white of the eye” membrane). These commonly contain tiny clear cysts on slit-lamp examination, a reassuring feature, and malignant transformation is uncommon. ³
The key patient takeaway is simple: “freckle” describes appearance, not diagnosis. What matters is (1) exact location, (2) documented change over time, and (3) whether any validated risk factors are present. ¹ ²
References
- Chien JL, Sioufi K, Surakiatchanukul T, Shields JA, Shields CL. Choroidal nevus: a review of prevalence, features, genetics, risks, and outcomes. Current Opinion in Ophthalmology. 2017;28(3):228-237. doi:10.1097/ICU.0000000000000361. PMID: 28141766.
- Shields CL, Furuta M, Berman EL, Zahler JD, Hoberman DM, Dinh DH, et al. Choroidal nevus transformation into melanoma: analysis of 2514 consecutive cases. Archives of Ophthalmology. 2009;127(8):981-987. doi:10.1001/archophthalmol.2009.151. PMID: 19667334.
- Huang JJ, Locatelli EVT, Chocron A, Camacho MR, Dubovy S, Karp CL, et al. Conjunctival nevus. Current Ophthalmology Reports. 2023;11(4):104-112. doi:10.1007/s40135-023-00315-w. PMID: 38390435.
Related Topics
- When Does a “Freckle” in the Eye Become Concerning?
- What Does a “Freckle in the Eye” Actually Mean? Choroidal, Iris and Conjunctival Naevi Explained
- Choroidal Naevus vs Choroidal Melanoma: Understanding TFSOM-DIM Risk Factors
- How Often Should a Choroidal Naevus Be Checked? Follow-Up Intervals and Imaging Plans
- Iris “Freckles”: Using the ABCDEF Guide to Spot Higher-Risk Iris Naevi
- Conjunctival “Freckles” on the White of the Eye: When a Naevus Is Usually Harmless
- Primary Acquired Melanosis (PAM): Why Some Flat Conjunctival Pigment Needs Oncology Input
- Eye Freckle Symptoms You Shouldn’t Ignore: Blurred Vision, Distortion, Hyphema and Pain
- Multimodal Imaging for Eye Freckles: Optical Coherence Tomography, Autofluorescence, Ultrasound and Photography
- MOLES and TFSOM-DIM: How Specialists Score Choroidal Naevi and Decide on Referral
- Growth Without Transformation: When a Choroidal Naevus Gets Bigger but Isn’t Melanoma
- High-Risk Features in Conjunctival Pigmented Lesions: PAM, Forniceal Location and Feeder Vessels
- Eye Freckles in Young Patients: Special Considerations for Iris and Choroidal Naevi Under 40
- Monitoring an Eye Freckle Safely: Why Baseline Photos and Structured Recall Matter
- When Does an Eye Freckle Need Biopsy or Treatment Instead of Observation?
- Living With an Eye Freckle: Cancer Risk, Prognosis and When to Seek a Second Opinion
- Eye Freckle Assessment at Blue Fin Vision®: Photography and Optical Coherence Tomography
- B-scan Ultrasound for Eye Freckles: Measuring Thickness and Looking for Melanoma Features
- Monitoring a Choroidal Naevus at Blue Fin Vision®: Structured Imaging, Written Plans and When We Refer
- Second Opinion on a ‘Suspicious’ Eye Freckle: Differentiating Naevus from Choroidal Melanoma
- Linked Care With Ocular Oncology: Fast Referral and Follow-Up if Melanoma Is Suspected
