Monitoring a choroidal naevus is safest when it is measured, documented, and compared over time. The first visit should produce a baseline record: lesion dimensions and position, OCT evaluation for subretinal fluid, and ultrasound thickness when appropriate. ¹ ³
Risk classification is based on objective features associated with growth:
- Thickness and ultrasound characteristics
- Subretinal fluid on OCT
- Orange pigment patterns
- Symptoms and proximity to the optic disc ¹
- Documented enlargement on serial images ²
Low-risk lesions can usually be monitored with periodic imaging once stability is confirmed. Lesions with one or more risk features often require shorter recall intervals and/or ocular oncology involvement depending on the risk profile. ¹
The clinical aim is balanced: avoid over-treating stable naevi, while ensuring that early melanomas are not missed. ² A written plan matters for both safety and reassurance: diagnosis, risk features present/absent, recall timing, and what changes would trigger escalation. ³
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.
- 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.
- 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.
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