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Study Identifies Risk Factors for Transformation of Choroidal Nevus Into Melanoma CHICAGO -- August 10, 2009 -- Eight factors may predict whether a choroidal nevus may develop into melanoma, according to a study published in the August issue of the Archives of Ophthalmology. "There is strong interest for early detection of choroidal melanoma, and its differentiation from nevus continues to be the major impediment," the authors wrote. "The challenge is to identify the single small melanoma among the thousands of choroidal nevi." Carol L. Shields, MD, Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, and colleagues studied the medical records of 2,514 consecutive eyes of patients with choroidal nevi between 1974 and 2006. The tumours had a median diameter of 5 mm and a median thickness of 1.5 mm at the beginning of the study. Choroidal nevi grew into melanoma in a total of 180 eyes (7%) over an average follow-up of 53 months, including 2% after 1 year, 9% after 5 years, and 13% after 10 years. The factors that predicted growth into melanoma included 5 previously identified factors: tumour thickness greater than 2 mm, fluid beneath the retina, symptoms such as decreased vision or flashes and floaters, orange pigment and a tumour edge within 3 mm of the optic disc. Two new factors were also identified: hollowness of the growth on ultrasound and the absence of a surrounding halo, or circular band of depigmentation. "Until systemic therapies for metastastic uveal melanoma improve, our focus should be on early detection to minimise metastastic disease," the authors wrote. "All ophthalmologists should participate in this effort and patients with risk factors can be referred for evaluation at centres familiar with the nuances in the diagnosis and management of early melanoma." Patients with choroidal nevi that do not display any of the 7 features of disease should be monitored twice yearly at first and then followed up yearly if their condition remains stable; those with 1 or 2 features should be monitored every 4 to 6 months; and those with 3 or more features should be evaluated at an experienced centre for possible treatment, they concluded. SOURCE: Archives of Ophthalmology E-mail this page to a friend or colleague! To print, use this version