Size Overlap between Benign Melanocytic Choroidal Nevi and Choroidal Malignant Melanomas

Augsburger, James J.; Corrêa, Zélia M.; Trichopoulos, Nikolaos; Shaikh, Adeel H.

doi:10.1167/iovs.07-1603

Cited by 37 publications

(29 citation statements)

References 23 publications

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“…However, size (mainly a lesion’s thickness but also the basal diameter) is one of the most important clinical features. If a lesion enlarges convincingly during follow-up, most ophthalmologists classify the tumor as at least probable choroidal melanoma 25. Nevertheless, clinical classification of pigmented choroidal lesions is often a great challenge for ophthalmologists 13.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, clinical classification of pigmented choroidal lesions is often a great challenge for ophthalmologists 13. One reason for that may be a substantial overlap between choroidal nevi and melanoma, particularly for tumors between 1.5 and 3 mm of thickness having a basal diameter between 5 and 9 mm 25. Standardized A-scan US has become a valuable aid to establish the diagnosis of choroidal melanoma in such cases 20.…”

Section: Discussionmentioning

confidence: 99%

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Choroidal pigmented lesions imaged by ultra-wide-field scanning laser ophthalmoscopy with two laser wavelengths (Optomap)

Kernt¹

2010

OPTH

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Purpose:Clinical differentiation of choroidal pigmented lesions is sometimes difficult. Choroidal melanoma is the most prevalent primary neoplasia among malignant ocular tumors, and metastasis often occurs before the primary tumor is diagnosed. Therefore, early detection is essential. We investigated the imaging properties of clinically diagnosed melanocytic choroidal tumors using a nonmydriatic ultra-wide-field scanning laser ophthalmoscope (SLO) with two laser wavelengths to distinguish benign from malignant lesions. Repeated standardized ultrasound (US) evaluation provided reference standard.Methods:In a consecutive series of 49 patients with clinically diagnosed melanocytic choroidal tumors in one eye, 29 had established melanoma (defined by proven growth on repeated US follow-up) and 20 had nevi (defined by no malignancy according to clinical, US, and growth characteristics for at least 2 years). All patients underwent clinical examination, undilated Optomap® (Optos PLC, Dunfermline, Fife, Scotland, UK) imaging, standardized US examination, and standard retinal photography. Measurements of the tumor base using the Optomap software were compared with US B-scan measurements. Imaging characteristics from the SLO images were correlated with the structural findings in the two patient groups.Results:Measurements of tumor base correlated well between SLO and US with r = 0.61 (T-direction) and r = 0.51 (L-direction). On SLO imaging, typical malignant lesions appeared dark on the red laser channel and bright on the green laser channel. Based on those simple binary characteristics, a sensitivity of 76% at a specificity of 70% was obtained for a correct classification of lesions. When analogous to clinical examination lesion size, margin touching the optic disc, and existence of subretinal fluid were additionally considered, 90% sensitivity at 82% specificity was obtained.Conclusions:In this first, limited series, nonmydriatic SLO imaging with two laser wavelengths permitted to differentiate malignant ocular tumors from nonmalignant lesions with high diagnostic accuracy. Additional parameters may further enhance diagnostic properties, but larger patient series are required to validate our findings and prove the diagnostic properties.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Choroidal pigmented lesions imaged by ultra-wide-field scanning laser ophthalmoscopy with two laser wavelengths (Optomap)

Kernt¹

2010

OPTH

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“…With MOLES, tumor thickness > 2mm is given a score of 2 because it is associated with the most significant hazard ratio out of all the risk factors for growth at five years. [11] A study by Augsburger et al indicates that there are 125 choroidal nevi for every melanoma in the thickness range of 1.5 to 2 mm, 25 nevi for every melanoma in the thickness range of 2 to 2.5 mm, and 5 nevi for every melanoma in the thickness range of 2.5 to 3 mm, approximately [22].…”

Section: Moles Rationalementioning

confidence: 99%

The MOLES System for Planning Management of Melanocytic Choroidal Tumors: Is It Safe?

Roelofs

O’Day

Harby

et al. 2020

Cancers

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Purpose: To evaluate the MOLES system for identifying malignancy in melanocytic choroidal tumors in patients treated for choroidal melanoma. Methods: Records of 615 patients treated for choroidal melanoma between January 2017 and December 2019 were reviewed. Patients were excluded if iris and/or ciliary body involvement (106 patients), inadequate fundus photography (26 patients), no images available for review (21 patients) and/or treatment was not primary (11 patients). Demographic data and AJCC TNM Stage were collected. Color fundus and autofluorescence photographs (FAF), optical coherence tomography (OCT) and B-scan ultrasounds were prospectively reviewed. MOLES scores were assigned according to five criteria: mushroom shape, orange pigment, large size, enlarging tumor and subretinal fluid. Results: A total of 451 patients (mean age, 63.9 ± 13.9 years) were included. At treatment, mean largest basal tumor diameter (LBD) and thickness were 10.3 ± 2.8 mm (range, 3.0–23.0) and 4.3 mm (range, 1.0–17.0). All but one (0.2%) had MOLES scores of ≥3. Eighty-two patients were treated after surveillance lasting a mean of 1.5 years. Initially, most (63/82; 76.8%) had a MOLES score ≥ 3. Importantly, none of the 451 tumors had a score of <2, and as such, the MOLES protocol would have indicated referral to an ocular oncologist for 100% of patients. Conclusion: The MOLES scoring system is a sensitive (99.8%) tool for indicating malignancy in melanocytic choroidal tumors (MOLES ≥ 3). If the examining practitioner can recognize the five features suggestive of malignancy, MOLES is a safe tool to optimize referral of melanocytic choroidal tumors for specialist care.

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“…13 Uveal nevi are generally flat, slate-gray lesions without sharply demarcated margins; their size is limited to about 6 mm in diameter. 14 However, there is considerable overlap in size distributions of nevi and indeterminate lesions compared with small melanomas, 15 and the differential diagnosis can be especially difficult in borderline cases with characteristics of both lesions. 16 While most studies have evaluated the growth potential of nevi and indeterminate pigmented lesions of the uveal tract, the eventual mortality associated with such lesions is not known.…”

Section: T Here Is Considerable Evi-mentioning

confidence: 99%

Mortality After Diagnosis of Small Melanocytic Lesions of the Choroid

Lane

Egan²,

Kim³

et al. 2010

Arch Ophthalmol

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To evaluate the risk of dying of metastatic choroidal melanoma in patients with small, indeterminate, pigmented lesions of the uveal tract. Methods: A cohort of 1063 consecutive patients were evaluated in the Ocular Oncology Clinic of the Massachusetts Eye and Ear Infirmary between January 1976 and June 1996 with definite choroidal nevus (n = 256), indeterminate lesions (n=334), or small melanoma (n=373). Deaths occurring up to December 1998 were identified through active follow-up or by a search of the National Death Index. Cumulative death rates were compared among diagnostic groups using the Kaplan-Meier method. Results: Mean lesion diameter was 4.6 mm in the nevi, 7.0 mm in the indeterminate lesions, and 8.1 mm in the small melanomas. Patients ranged in age from 3 to 95 years (median, 64 years). A total of 15 deaths due to ocular melanoma were ascertained (median follow-up of survivors, 8.2 years), 13 in the melanoma group and 2 in the indeterminate lesion group; actuarial tumorspecific death rates at 10 years after evaluation were 5% (95% confidence interval, 3%-8%) and 1% (95% confidence interval 0%-3%), respectively. No deaths due to ocular melanoma occurred in the nevus group. Conclusions: These data document the very low malignant potential of most indeterminate melanocytic lesions of the choroid and support the current practice of monitoring these tumors, with treatment provided when growth and other signs of malignant transformation are observed.

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Size Overlap between Benign Melanocytic Choroidal Nevi and Choroidal Malignant Melanomas

Cited by 37 publications

References 23 publications

Choroidal pigmented lesions imaged by ultra-wide-field scanning laser ophthalmoscopy with two laser wavelengths (Optomap)

Choroidal pigmented lesions imaged by ultra-wide-field scanning laser ophthalmoscopy with two laser wavelengths (Optomap)

The MOLES System for Planning Management of Melanocytic Choroidal Tumors: Is It Safe?

Mortality After Diagnosis of Small Melanocytic Lesions of the Choroid

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