History
- Decreased visual acuity, flickering, flashes
- Systemic history (neoplasms, risk factors, UV exposure)
Differential Diagnosis
Hamartoma of the RPE/retina, congenital hypertrophy of the RPE (CHRPE), nevus, melanoma
Diagnostics
- Subjective visual acuity
- Applanation tonometry and disc assessment
- Anterior segment (pigmented lesions)
- Fundus examination under mydriasis (hyperpigmented lesions),
- Fundus photography
- FAF
- OCT (through the lesion)
- FA/ICG if applicable
Management
Depending on findings and suspicion of malignancy
- Low suspicion of malignancy
- Follow-up after 3-6 months
- If stable for over 12 months > annual follow-up
- Suspected melanoma: refer to Ophthalmic Oncology, Jules Gonin Hospital, Lausanne
Classifications
Carol Shields Classification, Will's Eye Hospital
"To Find Small Ocular Melanoma Doing IMaging"
- T: Thickness > 2 mm (OCT/ultrasound)
- F: subretinal Fluid (OCT)
- S: symptoms of vision loss
- O: Orange pigment (autofluorescence)
- M: Melanoma hollow (ultrasound)
- DIM: Diameter > 5mm (fundus photograph)
Risk factor evaluation (5-year growth)
0 > 1%
1 > 11%
2 > 22%
3 > 34%
4 > 51%
5 > 55%
6 > Melanoma
Bertil Damato, Moorfields Eye Hospital
"MOLES"
- Mushroom shape
- Early tumor spread through RPE > 1
- Mushroom shape with overhang > 2
- Orange pigment
- Trace (fine hyper-FAF specks)
- Confluent, easily visible clumps of orange pigment > 2
- Large size
- Subtle dome shape and/or 3-4 disc diameters wide > 1
- Thickening (<2mm) and/or more than 4 disc diameters wide > 2
- Enlargement
- Suspected change > 1
- Definite growth (confirmed by photo) > 2
- Subretinal fluid
- Trace (OCT) > 1
- Definite (visible on fundoscopy) > 2
Sources: Damato BE, Eye, 2023,
