Fineman_Retina (Color Atlas and Synopsis of Clinical Ophthal

CHOROIDAL NEVUS 271

Prognosis and Management ● All small choroidal melanocytic tumors have the potential for malignant transforma tion and metastasis. Clinically observable risk factors for growth are as follows: Greater thickness ( > 2 mm) Largest basal diameter greater than 12 mm Subretinal fluid Symptoms of flashes or blurred vision Orange pigment Acoustic hollowness on B-scan

examination. Specific OCT changes may assist in the differentiation of choroidal neoplasm from inflammatory or infectious lesions, as well as in the differentiation of a benign choroidal nevus from a small cho roidal melanoma. For example, the findings on OCT of intraretinal cystic changes, RPE alterations, photoreceptor loss, and RPE detachment are related to chronic retinal degeneration and suggest a stable, chronic choroidal nevus. Conversely, the presence of subretinal fluid and photoreceptor pres ervation (so-called shaggy photoreceptors) suggests a more acute progression of a more active lesion with a higher risk of growth into melanoma. ● Tumor biopsy with appropriate genetic analysis of suspicious nevi ( Fig. 6-14 ) may be performed to assess the risk of malignant con version and metastasis. Histopathologic anal ysis of cytologic specimens may be helpful but is often less specific than genetic testing.

ultrasonography Absence of halo Absence of drusen

● Management consists of baseline photo graphs and regular examination to establish quiescence or growth of the nevus. Serial photographs, ultrasonography, autofluores cence, and more frequent examinations are indicated in cases of suspected growth.

Copyright © 2024 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.