Abstract
PurposeTo define, describe, and illustrate a previously unreported category of discrete melanotic choroidal melanocytic lesion.MethodsProspective ophthalmoscopic study of the ocular fundi of 79 light-skinned persons 50 years of age or older not referred for any evident fundus lesion, with detection of all evident discrete melanotic choroidal lesions > 0.3 mm in largest basal diameter.ResultsOne or more discrete dark-brown to gray choroidal lesions > 0.3 mm in largest basal diameter were detected in 27 of the 79 evaluated subjects (34.2%). All but four of the detected lesions were “flat” by both ophthalmoscopy and ultrasonography. A single flat lesion was present in one eye of 14 subjects whose fellow eye was normal, 2 or more flat lesions were evident in one eye of 5 subjects whose other eye was normal, and one or more lesions were evident in both eyes of 6 subjects.ConclusionWhile some of the discrete small, flat melanocytic choroidal lesions detected in this study might have been choroidal nevi, the author hypothesizes that an indeterminate proportion of them may have been focal aggregates of normal or near normal uveal melanocytes (FANNUMs).
Highlights
Most ophthalmologists know what a choroidal nevus is and believe that they can recognize one when they see it
Because clinicians cannot ascertain whether the component uveal melanocytes of an observed melanocytic choroidal lesion are benign or malignant and, if benign, normal, or atypical, they use clinical criteria
A few definitions specify a minimal largest basal diameter required for classification as a choroidal nevus; interestingly, none of the authors who mention a minimal required lesion diameter for diagnosis indicate how they would classify a discrete melanotic choroidal lesion smaller than the specified dimension
Summary
Most ophthalmologists know (or think they know) what a choroidal nevus is and believe that they can recognize one when they see it. Most clinical definitions of a choroidal nevus include a statement indicating the maximal allowable size of the lesion (usually about 5 mm in largest basal diameter [2] but up to 10 mm according to some authors [3] and usually about 1 mm in thickness [3] but up to 3 mm in some cases [4]). A few definitions specify a minimal largest basal diameter required for classification as a choroidal nevus (from as small as 0.35 mm [7] or 0.5 mm [8] to as large as 1.5 mm [5, 9]); interestingly, none of the authors who mention a minimal required lesion diameter for diagnosis indicate how they would classify a discrete melanotic choroidal lesion smaller than the specified dimension. Some authors use different diagnostic criteria for choroidal nevi in different reported studies
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