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Michael D Yu, Lauren A Dalvin, Carol L Shields; Clinical Features and Multimodal Imaging Characteristics of Choroidal Nevi in Pediatric Patients. Invest. Ophthalmol. Vis. Sci. 2018;59(9):3638.
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© ARVO (1962-2015); The Authors (2016-present)
There are currently no large series examining clinical features and multimodal imaging characteristics of choroidal nevi in pediatric patients. We performed a retrospective, clinical observational study to assess presenting features of choroidal nevi in children.
We included patients less than 18 years of age (pediatric) seen at a single tertiary referral center (Wills Eye Hospital) with choroidal nevus confirmed by clinical examination and ultrasonography. Clinical records were retrospectively reviewed for patient demographics and nevus characteristics, including largest basal diameter (LBD) and thickness, tumor pigmentation, and presence of subretinal fluid (SRF), orange pigment, retinal pigment epithelium (RPE) alterations, and/or drusen. Clinical features were correlated with optical coherence tomography (OCT), autofluorescence (AF), and near-infrared reflectance (nIR) findings. Fisher’s exact test was performed to identify correlations between presenting features and transformation into choroidal melanoma.
There were 79 affected pediatric patients with 85 choroidal nevi in 81 eyes. Mean patient age was 12 years (median 12, range 2-17). Clinical examination revealed typically pigmented (94.1%) lesions with mean LBD of 3.4 mm (median 2, range 0.1-20). By ultrasonography, mean thickness was 1.06 mm (median 1, range 0.1-3). On nIR imaging, nevi were hyperreflective (36.9%), isoreflective (40%), and hyporeflective (23.1%). Drusen and RPE alterations were seen in 3 (3.5%) and 9 (11.4%) nevi, respectively. SRF was noted initially in 7 (8.2%) nevi. After mean follow-up of 44 months (median 40, range 4-111), 2 (2.4%) nevi transformed into melanoma at 50 and 55 months. Acoustic hollowness (n=4, 4.7%) was significantly associated with transformation to melanoma (p=0.002) and was seen in both nevi that transformed. Transformation coincided with the detection of new SRF by OCT in both cases and orange pigment by AF in 1 case. Separately, 4 (4.7%) nevi grew without malignant transformation; in all 4 cases, growth occurred during the pubertal age range, with mean LBD increase of 1.75 mm (range 0.5-3.5) and no notable change in thickness.
Choroidal nevi in the pediatric population tend to be small and lack features of chronicity, such as drusen or RPE alterations. Transformation into melanoma is rare and may be heralded by key imaging features.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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