Structured scoring systems help standardise when a choroidal naevus is safe to monitor and when it should be escalated. Two commonly used approaches are:
- TFSOM-DIM: focuses on features strongly associated with transformation risk, including thickness, subretinal fluid, symptoms, orange pigment, margin near the optic disc, ultrasound features (such as hollowness), and absence of protective signs (such as halo). ¹
- MOLES: a clinically practical system based on Mushroom shape, Orange pigment, Large size, Enlargement, and Subretinal fluid, designed to support consistent referral decisions and avoid unnecessary oncology referrals for low-risk lesions. ² ³
In large datasets, the probability of growth rises as risk features accumulate, this is why clinicians prefer objective scoring over “it looks fine.” ¹ MOLES can be especially helpful where ultrasound is not immediately available, while TFSOM-DIM remains core in ocular oncology settings with full imaging suites. ²
At Blue Fin Vision®, the practical workflow is: baseline photography + OCT, add ultrasound where appropriate, then document risk features explicitly and refer when thresholds are met.
References
- 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.
- Roelofs KA, O’Day R, Al Harby L, Hay G, Arora AK, Keane PA, et al. The MOLES system for planning management of melanocytic choroidal tumors: is it safe for non-specialists? Cancers (Basel). 2020;12(6):1549. doi:10.3390/cancers12061549. PMID: 32455720.
- Al Harby L, Sagoo MS, O’Day R, Hay G, Arora AK, Keane PA, et al. Distinguishing choroidal nevi from melanomas using the MOLES algorithm: evaluation in an ocular nevus clinic. Ocular Oncology and Pathology. 2021;7(4):294-302. doi:10.1159/000514886. PMID: 34604203.
Related Topics
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- 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
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- 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
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- 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
