Imaging matters when judging ‘risky nevi’
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In the past, only clinical factors were used to judge “risky nevi,” but imaging modalities are predictive tools for identifying choroidal nevus risk factors for growth to melanoma, according to Carol L. Shields, MD.
“Imaging matters,” Shields said at the Women in Ophthalmology Summer Symposium.
In a study published in Retina, Shields and colleagues reported imaging 3,806 cases and reported Kaplan-Meier estimates of nevus transformation into melanoma of 1.2% at 1 year, 5.8% at 5 years and 13.9% at 10 years in the 2,355 cases available for follow-up.
“We constructed six factors that were highly significant in prediction of conversion of nevus into melanoma. We remember them by this mnemonic: to find small ocular melanoma doing imaging (TFSOMDIM),” Shields said.
Each letter represents a risk factor. T stands for thickness greater than 2 mm, F stands for fluid, S stands for symptoms, O stands for orange pigment, M stands for melanoma hollow, and DIM stands for diameter greater than 5 mm.
“These were highly significant in prediction of growth of nevus into melanoma,” Shields said. “The big three were thickness over 2 mm, subretinal fluid and orange pigment.”
Many imaging modalities, including ultrasonography, OCT, fundus photography and autofluorescence, are used when assessing a patient with choroidal nevus for risk factors.
If a patient has no factors, there is a 1% 5-year risk for growth, Shields said.
A patient with one factor has an 11% risk; with two factors, a 22% risk; with three factors, a 34% risk; with four factors, a 51% risk; and with five factors, a 55% risk, Shields and colleagues reported.
Outcomes do vary based combinations of risk factors, with some combinations yielding higher risk and some lower risk, Shields said.
“Beware of thickness, fluid and orange pigment,” Shields said.
Reference:
- Shields CL, et al. Retina. 2019;doi:10.1097/IAE.0000000000002440.
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Shields CL. Smart imaging of choroidal nevus and how it works. Presented at: Women in Ophthalmology Summer Symposium; Aug. 26-29, 2021; Amelia Island, Florida.
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