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What Is a Choroidal Nevus?

A choroidal nevus is a benign accumulation of melanocytes within the choroid, the vascular layer beneath the retina. It appears on fundus examination as a flat or mildly elevated gray or brown patch, most commonly in the posterior pole. Many choroidal nevi are discovered incidentally during routine eye exams and cause no symptoms. A small subset can grow and transform into choroidal melanoma, so certain risk features are watched closely. Documentation and regular follow up help distinguish stable nevi from lesions that need treatment.

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What Is a Choroidal Nevus?

A choroidal nevus is a benign accumulation of melanocytes within the choroid, the vascular layer beneath the retina. It appears on fundus examination as a flat or mildly elevated gray or brown patch, most commonly in the posterior pole. Many choroidal nevi are discovered incidentally during routine eye exams and cause no symptoms. A small subset can grow and transform into choroidal melanoma, so certain risk features are watched closely. Documentation and regular follow up help distinguish stable nevi from lesions that need treatment.

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Appearance and Imaging Characteristics

Choroidal nevi often have smooth margins and minimal elevation, with overlying drusen or retinal pigment epithelial changes developing over time. They may be slate gray, brown, or occasionally amelanotic. On ultrasonography, typical nevi have low internal reflectivity and are relatively thin. Optical coherence tomography shows subtle elevation and sometimes disruption of the outer retina or retinal pigment epithelium. Autofluorescence and angiography can highlight associated pigment or lipofuscin changes that inform risk assessment.

Risk Factors for Malignant Transformation

Risk features for growth toward melanoma include thickness beyond a few millimeters, subretinal fluid, orange lipofuscin pigment on the surface, symptoms such as decreased vision or flashes, and proximity to the optic disc. The presence of multiple risk features increases concern and prompts closer surveillance. Systemic factors such as fair skin, light iris color, and a history of cutaneous melanoma are also considered. Most nevi remain stable, but careful observation allows timely detection of those that change.

Diagnosis and Surveillance

Diagnosis is based on fundus examination supported by imaging studies. Color photography records baseline size and appearance. B scan ultrasound measures thickness and internal structure, while OCT evaluates the overlying retina and presence of subretinal fluid. Follow up visits compare current findings with prior records to detect subtle growth. When features strongly suggest melanoma, referral to an ocular oncology service is made for further evaluation and management.

Management and Prognosis

Most choroidal nevi require no active treatment beyond periodic monitoring. Patients are educated about reporting new visual symptoms, such as distortion or a new scotoma. When melanoma is diagnosed, treatment options include plaque radiotherapy, proton beam therapy, or enucleation in advanced cases. Prognosis for stable nevi is excellent, while outcome in melanoma depends on tumor size, location, and timely treatment. Regular surveillance balances safety with avoidance of unnecessary intervention.

FAQs About Choroidal Nevi

Is a choroidal nevus like a mole in the eye?

Yes, it is a mole like collection of pigment cells in the choroid and is usually benign.

Can a choroidal nevus make me lose vision?

Most do not affect vision, but those with subretinal fluid or macular involvement can cause distortion or blur.

How often should a choroidal nevus be monitored?

Follow up is often yearly for low risk lesions and more frequent for nevi with concerning features.

Does having a choroidal nevus mean I will get eye cancer?

No, only a small fraction transform into melanoma, but monitoring helps catch concerning change early.

References

American Academy of Ophthalmology (EyeNet). ?Distinguishing a Choroidal Nevus From a Choroidal Melanoma.? https://www.aao.org/eyenet/article/distinguishing-choroidal-nevus-from-choroidal-mela

American Academy of Ophthalmology (EyeWiki). ?Choroidal and Ciliary Body Melanoma.? https://eyewiki.org/Choroidal_and_Ciliary_Body_Melanoma

Retinal Physician. ?Best Practices Regarding Choroidal Nevus Follow-up.? https://www.retinalphysician.com/issues/2024/novemberdecember/choroidal-nevus-followup/

PubMed Central (PMC). ?Choroidal Melanoma: A Mini Review.? https://pmc.ncbi.nlm.nih.gov/articles/PMC9863301/

American Academy of Ophthalmology (EyeWiki). ?Choroidal and Ciliary Body Melanoma (Risk Features Section).? https://eyewiki.org/Choroidal_and_Ciliary_Body_Melanoma