Giant Choroidal Nevus. Clinical Features and Natural Course in 322 Cases

Helen K. Li, Carol L. Shields, Arman Mashayekhi, Jessica D. Randolph, Tehara Bailey, Jake Burnbaum, Jerry A. Shields

Research output: Contribution to journalArticle

24 Scopus citations

Abstract

Purpose: Evaluation of clinical features and natural course of giant choroidal nevi (diameter ≥10 mm). Design: Retrospective observational case series. Participants: We included 322 eyes of 322 patients. Methods: Clinic-based study of tumor features, tumor outcome, and vision outcome. Kaplan-Meier analysis was used to assess time to transformation into melanoma. Cox proportional hazards regressions evaluated clinical factors predictive of nevus transformation into melanoma and nevus-related decreased vision (defined as <20/20 and unrelated to other eye pathology). Main Outcome Measures: Transformation of giant choroidal nevus into melanoma and nevus-related decreased vision. Results: A medical record review of 4100 patients diagnosed with choroidal nevus identified 322 (8%) giant choroidal nevi. Median nevus basal diameter was 11 mm (range, 10-24). Median thickness was 1.9 mm (range, 0-4.4). Related retinal findings included drusen overlying nevus (n = 261 [81%]), subretinal fluid (n = 26 [8%]), orange pigment (n = 4 [1%]), retinal pigment epithelial (RPE) detachment (n = 6 [2%]), hyperplasia (n = 48 [15%]), fibrous metaplasia (n = 48 [15%]), atrophy (n = 63 [20%]), or trough (n = 6 [2%]). Kaplan-Meier analysis estimated transformation into melanoma in 13% at 5 years and 18% at 10 years. Multivariate analyses revealed factors predictive of transformation into melanoma including involvement or close proximity to the foveola (P = 0.017) and acoustic hollowness (P = 0.052). Nevus-related decreased vision was found in 2.2% of eyes at initial visit and 3.7% at final visit (median 41 and mean 61 months follow-up). Factors associated with nevus-related decreased vision at initial visit included subretinal fluid (P = 0.001), involvement or close proximity to foveola (P = 0.005), RPE detachment (P = 0.033), and nevus-related choroidal neovascular membrane (P = 0.044). Factors predictive of nevus-related decreased vision at final visit included involvement or close proximity to the foveola (P = 0.001) and presence of symptoms at the initial visit (P = 0.032). Conclusions: Giant choroidal nevi can clinically resemble choroidal melanoma but show features of chronicity, such as overlying drusen and RPE alterations. Over time, 18% transformed into melanoma, underscoring the importance of life-long surveillance. Financial Disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Original languageEnglish (US)
Pages (from-to)324-333
Number of pages10
JournalOphthalmology
Volume117
Issue number2
DOIs
StatePublished - Feb 2010

ASJC Scopus subject areas

  • Ophthalmology

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