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

Fredy Geiger,Sandrine Zweifel,Marc Stahel,Maximilian Wiest,Sadiq Said,Daniel Barthelmes,Mario Toro,Anahita Bajka

doi:10.3390/curroncol29020087

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.

Highlights

Clinicians may broadly classify choroidal melanocytic tumors as benign or malignant lesions, with choroidal nevi comprising the benign counterpart to melanoma
We identified patients clinically diagnosed with choroidal melanoma, choroidal nevus, or indeterminate choroidal melanocytic lesion in our clinic between April 2008 and June 2021
During the entire observation period, no choroidal nevus and no indeterminate choroidal melanocytic lesion transformed into a choroidal melanoma

Summary

Introduction

Clinicians may broadly classify choroidal melanocytic tumors as benign or malignant lesions, with choroidal nevi comprising the benign counterpart to melanoma. Both histological evidence [1,2] and documented clinical cases [3,4] indicate that most intraocular melanomas may evolve from such benign uveal lesions. Even with all listed diagnostic tools, certain tumors cannot be accurately classified as choroidal nevus or choroidal melanoma. In these cases, the diagnosis of “indeterminate choroidal melanocytic lesion” is used to designate such tumors [11,12]. Due to the mentioned diagnostic uncertainty, these lesions require careful monitoring

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