“Growth” is alarming, but it does not always equal melanoma. Some choroidal naevi demonstrate slow enlargement without developing other high-risk features. ² The key clinical distinction is between:
- Benign enlargement: minimal/no change in thickness, no new subretinal fluid, no new orange pigment, stable symptoms
- High-risk growth: growth accompanied by new risk features (fluid, lipofuscin/orange pigment, increasing thickness, symptoms) ¹ ²
This is why follow-up relies on serial, standardised imaging, not subjective impressions. A lesion can appear larger because of better image quality, clearer media, or improved alignment, so clinicians prioritise measured basal dimensions and thickness, plus objective signs of activity. ³
Large series demonstrate that while many naevi remain stable, lesions with multiple risk factors have substantially higher rates of growth into melanoma. ² Conversely, real-world referral datasets also show that nevus growth can occur without melanoma transformation, reinforcing the need to interpret enlargement in context. ³
If growth is suspected, the safest pathway is repeat multimodal imaging, documentation of specific risk features, and early ocular oncology input when uncertainty remains. ¹ ²
References
- Shields CL, Cater J, Shields JA, Singh AD, Santos MC, Carvalho C. Combination of clinical factors predictive of growth of small choroidal melanocytic tumors. Archives of Ophthalmology. 2000;118(3):360-364. doi:10.1001/archopht.118.3.360. PMID: 10712878.
- 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.
- Qureshi MB, Lentz PC, Xu TT, White LJ, Olsen TW, Pulido JS, et al. Choroidal nevus features associated with subspecialty referral. Ophthalmology Retina. 2023;7(12):1097-1108. doi:10.1016/j.oret.2023.07.022. PMID: 37517800.
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