Borderline choroidal lesions exist: a small melanoma can resemble a benign naevus, especially early. Differentiation depends on synthesis of history, examination, and multimodal imaging. ¹ ²
Features that increase suspicion include:
- Thickness above 2 millimetres ¹
- Subretinal fluid
- Orange pigment/lipofuscin ³
- Symptoms (blur, distortion, scotoma)
- Margin near the optic disc
- Concerning ultrasound characteristics
A second opinion is appropriate if a lesion is labelled “suspicious” without clear evidence, if imaging is incomplete, or if the follow-up plan is unclear. Reassessment often involves repeating baseline tests, comparing prior images, and documenting risk features explicitly. ²
The goal is not to alarm patients; it is to ensure that classification is correct and that management matches risk. When uncertainty persists, ocular oncology input is the safest pathway. ³
References
- Shields CL, Demirci H, Materin MA, Marr BP, Mashayekhi A, Shields JA. Clinical factors in the identification of small choroidal melanoma. Canadian Journal of Ophthalmology. 2004;39(4):351-357. doi:10.1016/S0008-4182(04)80005-X. PMID: 15327099.
- 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.
- 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
