Eye pigmentation, elevated lesions feed choroidal melanoma rumor mill
WAILEA, Hawaii — The notion that all pigmentation in the eye is melanoma is a “rumor,” according to a speaker at Hawaiian Eye 2021.
Based on fundoscopy and ultrasound, “We look in the eye, we see what the tumor looks like, we make the diagnosis,” Jesse L. Berry, MD, said.
Pigmented lesions that do not signify melanoma include congenital hypertrophy of the retinal pigment epithelium (CHRPE), melanocytoma, vortex varis and choroidal nevi, Berry said.
Every lesion that is both pigmented and elevated must be a melanoma or a high-risk choroidal nevus is another such rumor.
“Choroidal nevi, in general, are benign tumors, but just like the skin, they have a risk of developing into malignant melanoma, so it is important to know what the risk factors are,” Berry said. “Any that have high-risk features, which predispose to growth, really should have closer follow-up, particularly if those high features are new.”
Thickness greater than 2 mm, fluid, orange pigment, margin greater than 3 mm to disc, ultrasonographic hollowness and halo absence are all signs of high-risk choroidal nevi, Berry said.
Peripheral exudative hemorrhagic chorioretinopathy and choroidal metastases are two potential explanations for patients with pigmented, elevated lesions.
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Berry JL. Dispelling rumors about tumors. Presented at: Hawaiian Eye; May 8-14, 2021; Wailea, Hawaii.
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