Assessing Choroidal Nevi, Melanomas and Indeterminate Melanocytic Lesions Using Multimodal Imaging—A Retrospective Chart Review

Abstract

Using multimodal imaging, the literature proposed the following risk factors for choroidal nevus growth into melanoma: increased tumor thickness, subretinal fluid, decreased visual acuity, presence of orange pigment, ultrasound acoustic hollowness, and increased tumor diameter. This study investigated the presence of the mentioned risk factors in choroidal nevi, choroidal melanomas, and indeterminate choroidal melanocytic lesions. This retrospective, single-center chart review assessed choroidal melanocytic tumors with multimodal imaging. We defined our primary outcome as the cumulative presence of mentioned risk factors. Further, we evaluated various optical coherence tomography (OCT), ultrasound, and autofluorescence findings. We analyzed 51 tumors from 49 patients during the period from April 2008 to June 2021. The median (IQR) age was 64.0 (56.0 to 70.5) years, with 23 of 49 (46.9%) patients being female. The follow-up time for all tumors was median (IQR) 25.0 (12.0 to 39.0) months. The choroidal nevi had a median (range) risk score of 0.0 (0.0 to 3.0), and the choroidal melanoma of 5.0 (3.0 to 6.0), with statistically significant different ratings (p < 0.001). Multimodal imaging creates a score that may help to distinguish choroidal nevi from choroidal melanomas objectively.

Predicting Malignant Transformation of Choroidal Nevi Using Machine Learning

“…Geiger et al used the TFSOM-DIM criteria to grade multimodal imaging by retrospective chart review, revealing signi cant differences in the range of risk scores between UM and choroidal nevi. 37 Other groups have independently identi ed risk factors for malignant transformation in melanocytic choroidal tumors. The Collaborative Ocular Melanoma Study (COMS) analyzed small choroidal lesions to nd that thickness greater than 2 mm, basal diameter greater than 12 mm, presence of orange pigment, and absence of drusen and RPE changes were predictive of tumor growth.…”

“…Geiger et al used the TFSOM-DIM criteria to grade multimodal imaging by retrospective chart review, revealing significant differences in the range of risk scores between UM and choroidal nevi. 37 …”

“De novo” Appearance of a Choroidal Melanoma During 5 Yearsʼ Follow-up for CHRPE

“…“Multimodal imaging is now an indispensable tool in ocular oncology for better definition of intraocular tumor features and surrounding tissue alterations,” confirmed the Shields et al in their recent article on risk factors for transformation of 2355 choroidal nevi into melanoma 5 . These risk factors, including tumor thickness > 2 mm, subretinal fluid, visual acuity of 20/50 or worse, detection of orange pigment, ultrasound acoustic hollowness, and tumor diameter > 5 mm, add up to a cumulative “risk” score 11 . Interestingly, only the tumorʼs diameter (> 5 mm or ~ 4DD) can be identified as a positive risk factor on the fundus photo ( Fig.…”

Multispectral Fundus Photography of Choroidal Nevi with Trans-Palpebral Illumination

“…This condition poses two associated risks: firstly, a benign nevus can transform into malignant melanoma, with risks of melanoma-related metastasis and mortality; and secondly, nevi may lead to vision impairment from subretinal fluid or secondary choroidal neovascularization 2, 3 . Early detection and careful progression monitoring of choroidal nevi are crucial as they are early-stage precursors to choroidal melanomas 4 . Shields et al 5 have proposed several risk factors associated with the transformation of choroidal nevus into melanoma.…”