Choroidal Melanocytic Lesions (also: Choroidal naevus, indeterminate melanocytic lesion, benign choroidal naevus, suspicious choroidal naevus)

What's going on?

The retinal pigment epithelium that lies underneath the retina is composed of pigmented cells. Excessive melanin in these cells will result in a localised naevus. Most naevi are completely benign, but some have malignant potential.

If I examine the patient, what will I find?

A pigmented lesion of variable size within the retinal pigment epithelial layer beneath the retina.

What if I've diagnosed it?

Refer routinely.

What will the hospital do?

The lesion will be assessed, photographed and probably scanned by ultrasound. Elevated lesions are a concern, as are yellowish pigment (lipofuscin) on the surface of the lesion or the presence of a retinal detachment around the pigmented area. The presence of drusen on the surface is an indication that the lesion is probably benign.

If the lesion is completely flat, the patient will probably be discharged. If the lesion is elevated and suspicious, the patient may be followed up on a six-monthly or yearly basis.

If there is a real concern that the pigmented lesion is a malignant melanoma, the patient will be referred to an ocular oncology centre.

A diagnosis of an indeterminate melanocytic lesion means that after assessment the exact nature of the lesion is still uncertain.

What to tell the patient

They have the ocular equivalent of a mole on their skin, which is unlikely to grow or become malignant but is worth keeping under observation, either by their optician or the hospital eye service.