Living With an Eye Freckle: Cancer Risk, Prognosis and When to Seek a Second Opinion

Being told you have a pigmented lesion in the eye can be unsettling, but most lesions labelled “freckles” are benign. The important principle is that risk is not uniform: the likelihood of transformation is concentrated in lesions with validated risk features and/or documented change over time. ¹

For choroidal naevi, large clinical series show that transformation into melanoma occurs in a minority overall, with probability rising as risk factors accumulate. ¹ ² For many patients, the most helpful reassurance is not “it’s fine,” but a clear explanation of what has been measured, what risk features are absent, and exactly how follow-up will detect change early.

A second opinion is reasonable if:

• The diagnosis is unclear (naevus vs indeterminate vs melanoma-suspect)
• You were not offered baseline imaging
• A lesion has risk features but no structured recall plan
• Symptoms are dismissed without examination and imaging

Specialist ocular oncology centres see borderline lesions routinely and can clarify risk, confirm imaging interpretation, and advise on surveillance versus treatment. ³

References

1. 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.
2. Singh AD, Kalyani P, Topham A. Estimating the risk of malignant transformation of a choroidal nevus. Ophthalmology. 2005;112(10):1784-1789. doi:10.1016/j.ophtha.2005.06.011. PMID: 16154197.
3. Shields CL, Shields JA. Melanoma of the eye: revealing hidden secrets, one at a time. Clinical and Experimental Ophthalmology. 2015;43(8):734-749. doi:10.1111/ceo.12547. PMID: 26213399.

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