Not infrequently a worried WebMD community member writes about findings made during a routine eye examination. Often it is the presence of a flat, pigmented mole in the back of the eye. The patient is beset with the news and the doctor departs without giving a complete explanation. (Perhaps the doctor gave a thorough explanation but the fretful patient was unable to process the information.)
There are several pigmented moles inside the eye but a choroidal nevus is the one that demands the most scrutiny. Choroidal locates the freckle to a layer of tissue underneath the retina – nevus means a benign growth of pigmented cells. Most choroidal nevi are safe and are managed with periodic exams. A small percentage of these nevi, however, can grow and become a choroidal malignant melanoma.
Eye specialists have recently published clinical data in the British Journal of Ophthalmology that describe long-term followup of patients with choroidal nevi. This study ran for 20 years and evalauted 659 patients. This is a select group. Most patients with choroidal nevi are never seen by an eye doctor because they have no symptoms or nobody looked. These 659 were referred for ongoing evaluation, making it a skewed population.
Painless ultrasound imaging was very effective in predicting which choroidal nevi would misbehave. It ended up that 17 (2.9%) within this study group developed choroidal melanoma at the site of previous nevi. 2.9%! Remember, it’s a skewed population! The ultrasound device measured both the size of the moles and their internal composition. A minimum of eighteen months’ followup was necessary before any nevus exhibited changes sufficient to call the lesion melanoma.
What does this new information mean? Most choroidal nevi remain benign in the vast majority of cases and expert ultrasound studies can help identify the earliest changes before any trouble starts.
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