Choroidal Naevi

What's going on?

Choroidal naevi are not uncommon and may, rarely, develop into malignancy in the form of a choroidal melanoma. Such lesions may metastasise.

If I examine the patient, what will I find?

You should be able to see the pigmented lesion in the fundus.

What if I've diagnosed it?

If you have seen a pigmented lesion in the back of the eye, it worth sending the patient to their optician for assessment. A key feature of the lesion is its elevation from the retina. With a direct ophthalmoscope, it can be difficult to see whether a lesion is markedly elevated or flat. The optometrist will use binocular ophthalmoscopy to assess whether a lesion is raised and suspicious. If a lesion is completely flat and quite small, it may simply be observed by regular yearly assessment by the optometrist. If a lesion is elevated, it is reasonable to refer to hospital for soon assessment.

The likelihood of malignancy is increased with the degree of elevation, the size of the lesion, the presence of orange pigment (called lipofuscin) on the surface and the presence of a surrounding retinal detachment.

What will the hospital do?

The patient will be clinically assessed and an ultrasound scan (called a B-scan) undertaken to determine elevation and internal reflectivity.

If the lesion is highly suspicious, the patient will be referred to a regional ocular oncology unit.

If the lesion is less suspicious, the patient will be reviewed by the ophthalmology service on a regular (usually yearly) basis.

If the lesion is clinically benign, it should ideally be photographed and the patient discharged. Recommend regular yearly ophthalmoscopy by the optometrist to detect any changes.

What to tell the patient

They have a mole at the back of their eye. If it were on their arm they could monitor it for change themselves, but naturally in this case their optometrist will need to check it regularly for them.