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H. K. Li, J. Randolph, A. Mashayekhi, C. L. Shields, T. Bailey, J. Burnbaum, J. A. Shields; Clinical Features and Natural Course of Giant Choroidal Nevus in 322 Cases. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5703.
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© ARVO (1962-2015); The Authors (2016-present)
Evaluation of the clinical features and natural course of giant choroidal nevi. There has been no previously published study on this topic.
Retrospective chart review of patients with diagnosis of giant choroidal nevus (≥10 mm diameter) managed at Wills Eye Institute Oncology Service from 1974 to 2008. Clinical exam records, fundus photographs, ultrasounds, optical coherence tomograms and available fundus fluorescein angiograms were reviewed for demographics, tumor features and natural course.
Of 4,100 choroidal nevi seen at the oncology service between 1974 and 2008, 322 (8%) were diagnosed as giant choroidal nevus and included in this study. No patient had more than one giant nevus. Ocular melanocytosis was observed in 3% of patients. Mean basal diameter was 11 mm (median 11 mm, range 10 - 24 mm) and mean thickness was 1.9 mm (median 1.9 mm, range 0 - 4.4 mm). Nevi were pigmented (70%), nonpigmented (10%), and partially pigmented (20%). A hypopigmented halo was present in 2% and involvement of ciliary body was seen in 7% of cases. Other features included overlying subretinal fluid (8%), drusen (81%), retinal pigment epithelium (RPE) atrophy (20%), hyperplasia (15%), fibrous metaplasia (15%), trough (2%), RPE detachment (2%), and orange pigment (1%). Subretinal fluid or edema involving the foveola was present in 7% of subfoveolar nevi but only <1 % of extrafoveolar nevi. Of 242 patients with follow-up visits at the oncology service (mean follow-up duration of 5.1 years), choroidal neovascular membrane developed in <1% and minimal nevus enlargement was noted in 5%. Kaplan-Meier estimates for transformation into melanoma were 13% at 5 years and 18% at 10 years.
Giant choroidal nevi (≥ 10 mm diameter) commonly show overlying chronic RPE alterations and drusen, but can clinically resemble melanoma. By 10 years follow up 18% show transformation into melanoma. Long-term monitoring of giant choroidal nevi is advised.
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