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

Roelofs, Kelsey A.; O’Day, Roderick; Harby, Lamis Al; Arora, Amit; Cohen, Victoria M L; Sagoo, Mandeep S.; Damato, Bertil

doi:10.3390/cancers12051311

Cited by 24 publications

(21 citation statements)

References 29 publications

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“…Urgent referral to an ocular oncologist is advised only for patients with probable melanoma. We have recently validated the MOLES scoring system in a dataset of predominantly choroidal nevi [ 28 ] and have found it to be a highly sensitive tool in a large cohort of choroidal melanomas [ 29 ]. The aim of this study was to determine if ultrasonography is necessary to detect progression of choroidal melanocytic tumors undergoing sequential color photography, AF and OCT.…”

Section: Introductionmentioning

confidence: 99%

Detecting Progression of Melanocytic Choroidal Tumors by Sequential Imaging: Is Ultrasonography Necessary?

Roelofs

O’Day

Harby

et al. 2020

Cancers

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Purpose: To determine if ultrasonography is necessary to detect progression of choroidal melanocytic tumors undergoing sequential multi-modal imaging with color photography, autofluorescence (AF) and optical coherence tomography (OCT). Methods: All patients with choroidal melanoma undergoing treatment at Moorfields Eye Hospital between January 2016 and March 2020 were reviewed to identify those with treatment deferred by ≥ 2 months. Tumors that showed progression prior to treatment, defined as an increase in (a) basal dimensions (b) thickness (c) orange pigment and/or (d) sub-retinal fluid, were included. Mushroom shape, Orange pigment, Large size, Enlargement and Sub-retinal fluid (MOLES) scores were assigned to all tumors at earliest date and date of treatment. Results: A total of 99 patients with a mean age of 66 years (range: 26–90) were included. The initial MOLES score was 1 in 2 cases, 2 in 23 cases, and ≥ 3 in 74 cases. Progression was detected with sequential color photography alone in 100% of MOLES 1/2 and 97% of lesions with a MOLES score of ≥ 3. When findings on AF and OCT were included, sensitivity for detecting subtle change without ultrasonography improved to 100% for MOLES 3 and 97% for MOLES 4/5. Only one patient included in this study had an isolated increase in thickness that may have been missed had sequential ultrasonography not been performed. Overall, the sensitivity for detecting progression with color photographs alone was 97% (95% CI 93–100%) and increased to 99% (95% CI 97–100%) by including autofluorescence and OCT. Conclusions: Monitoring of choroidal nevi, particularly those classified as MOLES 1 or 2 (i.e., low-risk or high-risk naevi), can be accomplished safely without the need for ultrasonography. The findings of this study may remove barriers to the implementation of tele-oncology clinics for the monitoring of choroidal melanocytic tumors.

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Section: Introductionmentioning

confidence: 99%

Detecting Progression of Melanocytic Choroidal Tumors by Sequential Imaging: Is Ultrasonography Necessary?

Roelofs

O’Day

Harby

et al. 2020

Cancers

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“…(17,18) Previous studies Roelofs et al evaluated the MOLES system in 450 choroidal melanomas treated at our center and found a MOLES score <3 in only one patient, whose tumor was located pre-equatorially. (7) This indicates that when used by an expert the risk of misdiagnosing choroidal melanomas as nevi is low.…”

Section: Discussion Of Resultsmentioning

confidence: 99%

“…Medical records and digital images were retrospectively scored and tumors categorized according to the MOLES system as 'common nevus', 'low-risk nevus', 'high-risk nevus' and 'probable melanoma'. (7) This was done according to clinical features documented at the patient's first visit at our hospital as described In Table 1, except that enlargement was documented if tumor growth was mentioned in the charts or referral letter. The experts' diagnosis was retrospectively categorized as melanoma if this was specified at initial assessment or if the patient underwent radiotherapy or other treatment for this condition.…”

Section: Methodsmentioning

confidence: 99%

“…Each of these features is scored between 0 and 2 and tumors are diagnosed according to their sum total as 'common nevus', 'low-risk nevus', 'high-risk nevus' or 'probable melanoma' as described previously (Table 1). (7) The aim of this study was to determine the sensitivity and specificity of the MOLES scoring system in differentiating choroidal melanomas from nevi.…”

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confidence: 99%

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Distinguishing Choroidal Nevi from Melanomas Using the MOLES Algorithm: Evaluation in an Ocular Nevus Clinic

et al. 2021

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Objective: The aim of this study was to determine the sensitivity and specificity of the MOLES scoring system in differentiating choroidal melanomas from nevi according to Mushroom shape, Orange pigment, Large tumor size, Enlarging tumor, and Subretinal fluid (SRF). Methods: Color photographs, fundus-autofluorescence images, and optical coherence tomography of 222 melanocytic choroidal tumors were reviewed. Each MOLES feature was retrospectively scored between 0 and 2 and tumors categorized as “common nevus,” “low-risk nevus,” “high-risk nevus,” and “probable melanoma” according to the total score. MOLES scores were compared with the experts’ diagnosis of melanoma. Results: The MOLES scoring system indicated melanoma in all 81 tumors diagnosed as such by ocular oncologists (100% sensitivity) and nevus in 135 of 141 tumors given this diagnosis by these experts (95.7% specificity). Of the 6 tumors with discordant diagnoses, 4 had basal diameters exceeding 6 mm, all with SRF and/or orange pigment, and 2 small tumors showed either significant SRF with traces of orange pigment, or vice versa. Conclusions: The MOLES system for diagnosing melanocytic choroidal tumors compares well with expert diagnosis but needs to be evaluated when deployed by ophthalmologists and community optometrists in a wide variety of working environments.

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“…5 Of these factors, tumor thickness greater than 2 mm carried the most significant hazard ratio for growth at 5 years. 5,14 For this reason, the MOLES (mushroom shape, orange pigment, large size, enlarging tumor, and subretinal fluid) system for planning management of choroidal tumors places substantial weight on tumor thickness for distinguishing between choroidal nevus and melanoma and determining subsequent management. 14 For choroidal melanoma, tumor size is important for the prognosis and treatment selection, planning, and delivery.…”

Section: Discussionmentioning

confidence: 99%

Conversion Factor for B‐Scan Ultrasound Measurement of Intraocular Tumors With and Without the Sclera

Tanke

Dalvin

2020

J of Ultrasound Medicine

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Objectives-To investigate the relationship between choroidal nevus and melanoma thickness measured with or without the sclera included by B-scan ultrasound and to present a simple conversion formula.Methods-Medical records were retrospectively reviewed for choroidal nevus or melanoma evaluated at the Mayo Clinic in Rochester, Minnesota, with B-scan ultrasound between February 4, 2004, and April 23, 2020. Charts were retrospectively reviewed for high-quality B-scan images in which the ultrasound transducer was perpendicular to the lesion, measuring the tumor thickness without the sclera included. Measurements were repeated with the sclera included for each patient. Univariate and multiple linear regression analyses were performed to identify factors correlated with scleral thickness.Results-There were 201 tumors included in the study, with a mean patient age AE SD of 61 AE 14 years, largest tumor basal diameter of 11.8 AE 4.8 mm, tumor thickness without the sclera included of 3.72 AE 2.7 mm, and thickness with the sclera included of 4.54 AE SD 2.8 mm. On the univariate analysis, factors associated with perceived scleral thickness by B-scan ultrasound included age (P < .001), tumor thickness (P < .001), and basal diameter (P = .06). On the multivariate analysis, factors associated with perceived scleral thickness included age and tumor thickness (P < .001) for all tumors and for the subset of 141 tumors with a thickness of 2 mm or greater (P < .001). For tumors of 2 mm or greater in thickness, perceived scleral thickness by ultrasound can be estimated by the formula 0.00495(patient age) + 0.02451(tumor thickness without the sclera) + 0.42549.Conclusions-We present a simple formula for converting between B-scan ultrasound measurements of choroidal nevus and melanoma measuring 2 mm or greater in thickness with and without the sclera included.

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

Cited by 24 publications

References 29 publications

Detecting Progression of Melanocytic Choroidal Tumors by Sequential Imaging: Is Ultrasonography Necessary?

Detecting Progression of Melanocytic Choroidal Tumors by Sequential Imaging: Is Ultrasonography Necessary?

Distinguishing Choroidal Nevi from Melanomas Using the MOLES Algorithm: Evaluation in an Ocular Nevus Clinic

Conversion Factor for B‐Scan Ultrasound Measurement of Intraocular Tumors With and Without the Sclera

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