title: Iris nevus growth into melanoma: analysis of 1611 consecutive eyes: the ABCDEF guide.
abstract: OBJECTIVE
  To determine clinical features predictive of growth of iris nevus into melanoma.
  
  
  METHODS
  Retrospective, comparative case series.
  
  
  METHODS
  A total of 1611 consecutive patients referred to an ocular oncology center with iris nevus.
  
  
  METHODS
  Observation and photographic documentation.
  
  
  METHODS
  Growth into melanoma.
  
  
  RESULTS
  The mean age at referral for iris nevus was 51 years (median, 54; range, <1-94 years). At presentation, the mean tumor basal diameter was 3 mm (median, 3 mm; range, <1-12 mm) and mean tumor thickness was 0.8 mm (median, 0.5 mm; range, 0-5 mm). All patients were initially diagnosed with benign iris nevus. Growth of iris nevus to melanoma was confirmed in 2% of eyes (n = 27) over a mean follow-up of 68 months (median, 46 months; range, 3-465 months). By Kaplan-Meier estimates, iris nevus growth to melanoma occurred in <1%, 3%, 4%, 8%, and 11% at 1, 5, 10, 15, and 20 years, respectively. Factors predictive of iris nevus growth to melanoma by multivariable analysis included age ≤ 40 years at presentation (hazard ratio [HR], 3), episode of hyphema (HR, 9), 4:00 to 9:00 clock hour location of tumor (HR, 9), diffuse tumor (involving entire iris surface) (HR, 14), ectropion uveae (HR, 4), and feathery tumor margins (HR, 3). Additional important factors by univariable analysis included tumor seeding on the iris or in the anterior chamber angle, feeder vessels, and nodule formation. These factors can be remembered using the mnemonic ABCDEF, representing A = age young, B = blood, C = clock hour inferior, D = diffuse, E = ectropion, and F = feathery margin.
  
  
  CONCLUSIONS
  In an analysis of 1611 cases of iris nevus referred for evaluation at an ocular oncology center, growth into melanoma occurred in 8% by 15 years. Risk factors for growth, identified by ABCDEF included Age young, Blood (hyphema), Clock hour inferior, Diffuse configuration, Ectropion uveae, and Feathery tumor margin.
authors.affiliation: Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA. carol.shields@shieldsoncology.com
authors.forename: Carol L
authors.initials: CL
authors.lastname: Shields
authors.forename: Swathi
authors.initials: S
authors.lastname: Kaliki
authors.forename: Anne
authors.initials: A
authors.lastname: Hutchinson
authors.forename: Stephanie
authors.initials: S
authors.lastname: Nickerson
authors.forename: Jinali
authors.initials: J
authors.lastname: Patel
authors.forename: Swarupa
authors.initials: S
authors.lastname: Kancherla
authors.forename: Ani
authors.initials: A
authors.lastname: Peshtani
authors.forename: Shazia
authors.initials: S
authors.lastname: Nakhoda
authors.forename: Kristen
authors.initials: K
authors.lastname: Kocher
authors.forename: Emily
authors.initials: E
authors.lastname: Kolbus
authors.forename: Emily
authors.initials: E
authors.lastname: Jacobs
authors.forename: Robert
authors.initials: R
authors.lastname: Garoon
authors.forename: Brianna
authors.initials: B
authors.lastname: Walker
authors.forename: Brittany
authors.initials: B
authors.lastname: Rogers
authors.forename: Jerry A
authors.initials: JA
authors.lastname: Shields
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000867:Anterior Chamber / Q000473:pathology*; D002471:Cell Transformation, Neoplastic / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007498:Iris; D015811:Iris Neoplasms / Q000473:pathology*; D008297:Male; D008545:Melanoma / Q000473:pathology*; D008875:Middle Aged; D009508:Nevus, Pigmented / Q000473:pathology*; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult