Giant choroidal nevus clinical features and natural course in 322 cases.
OBJECTIVE
Evaluation of clinical features and natural course of giant choroidal nevi (diameter >or=10 mm).


METHODS
Retrospective observational case series.


METHODS
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).


METHODS
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.
Li
Helen K
HK
Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
Shields
Carol L
CL
Mashayekhi
Arman
A
Randolph
Jessica D
JD
Bailey
Tehara
T
Burnbaum
Jake
J
Shields
Jerry A
JA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D002471:Cell Transformation, Neoplastic / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D002830:Choroid Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008297:Male; D008545:Melanoma / Q000473:pathology*; D008875:Middle Aged; D009508:Nevus, Pigmented / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D012189:Retrospective Studies; D014463:Ultrasonography; D014792:Visual Acuity
D007457:Iodine Radioisotopes