When a patient attends with a suspected “eye freckle,” the first priority is to map the lesion accurately and document a baseline that can be compared later. The exact tests depend on location. ¹
For suspected choroidal lesions, baseline assessment typically includes:
- Dilated examination and colour fundus photography (size and position)
- Optical coherence tomography (OCT) to detect subretinal fluid or retinal disruption ²
- Ultrasound where thickness and internal reflectivity need objective measurement
- Autofluorescence when lipofuscin/orange pigment assessment is clinically relevant ³
For iris and conjunctival pigment, slit-lamp photography is essential because subtle enlargement or vascular change can be difficult to judge from memory alone. ²
The clinical advantage of this approach is that risk is determined by objective features, not impression. Imaging also allows a clear written plan: whether the lesion is low-risk and suitable for surveillance, or whether risk features meet criteria for early ocular oncology input. ¹
References
- Pearce E, Simpson ARH, Keane PA, Sagoo MS, Damato B, Heimann H. Survey of ophthalmic imaging use to assess risk of progression of choroidal nevus to melanoma in the United Kingdom. Ophthalmology Retina. 2023;7(5):401-409. doi:10.1016/j.oret.2022.12.010. PMID: 36549472.
- Shields CL, Materin MA, Mashayekhi A, Shields JA. Optical coherence tomography of choroidal nevus in 120 patients. Retina. 2005;25(3):243-252. doi:10.1097/00006982-200504000-00001. PMID: 15805899.
- Dalvin LA, Shields CL, Lally SE, Huang X, Ancona-Lezama D, Williams BK Jr, et al. Combination of multimodal imaging features predictive of choroidal nevus transformation into melanoma. British Journal of Ophthalmology. 2019;103(10):1441-1447. doi:10.1136/bjophthalmol-2018-312967. PMID: 30523045.
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
