DeSimone Joseph D, Shields Charlotte N, Kalafatis Nicholas E, Marous Molly R, Marous Charlotte L, Shields Jerry A, Shields Carol L
Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Department of Dermatology, University of Rochester Medical Center, Rochester, New York, USA.
Clin Dermatol. 2024 Jan-Feb;42(1):38-45. doi: 10.1016/j.clindermatol.2023.10.012. Epub 2023 Oct 20.
A choroidal nevus is a common intraocular tumor in the United States, found in approximately 5% of Caucasian adults. The three main risks of melanocytic choroidal nevus include vision loss from a subfoveal nevus, development of subretinal fluid, and transformation of nevus into melanoma, a malignant counterpart. We explore clinical risk factors that predict benign melanocytic choroidal nevus transformation into a malignant choroidal melanoma. Based on a large analysis of 2,355 cases that were monitored longitudinally using multimodal imaging, the most recent list of clinical features includes tumor Thickness greater than 2 mm on ultrasonography, subretinal Fluid on optical coherence tomography, Symptomatic vision loss 20/50 or worse, Orange pigment on fundus autofluorescence, Melanoma hollow on ultrasonography, and DIaMeter greater than 5 mm on fundus photography. These factors are remembered with a mnemonic of the capital letters TFSOM-DIM for "To Find Small Ocular Melanoma Doing Imaging." Analysis of these factors demonstrated a Kaplan-Meier mean five-year risk of 1% with no risk factors, 11% with any one factor, 22% with any two factors, 34% with any three factors, 51% with any four factors, and 55% with any five factors. There was no patient with six risk factors. Of those with combinations of four risk factors, six of 15 combinations yielded a 70%-100% rate of transformation; of those with combinations of five risk factors, two of five combinations yielded a 70%-100% rate of transformation. Choroidal nevus carries a risk for evolving into melanoma, and understanding of clinical and imaging features predictive of this outcome is highly important.
脉络膜痣是美国常见的眼内肿瘤，约5%的成年白种人患有此病。黑色素性脉络膜痣的三个主要风险包括：黄斑下痣导致的视力丧失、视网膜下液的形成以及痣转变为恶性黑色素瘤。我们探究了预测良性黑色素性脉络膜痣转变为恶性脉络膜黑色素瘤的临床风险因素。基于对2355例病例的大型分析，这些病例通过多模态成像进行纵向监测，最新的临床特征列表包括：超声检查时肿瘤厚度大于2毫米、光学相干断层扫描显示视网膜下液、有症状的视力丧失且视力为20/50或更差、眼底自发荧光显示橙色色素、超声检查显示黑色素瘤空洞以及眼底照相显示直径大于5毫米。这些因素可以用首字母缩写TFSOM-DIM来记忆，即“通过成像发现小的眼内黑色素瘤”。对这些因素的分析表明，无风险因素时，根据Kaplan-Meier法计算的五年平均风险为1%；有任何一个因素时为11%；有任何两个因素时为22%；有任何三个因素时为34%；有任何四个因素时为51%；有任何五个因素时为55%。没有患者有六个风险因素。在有四个风险因素组合的患者中，15种组合中有6种的转变率为70%-100%；在有五个风险因素组合的患者中，5种组合中有2种的转变率为70%-100%。脉络膜痣有演变为黑色素瘤的风险，了解预测这一结果的临床和影像特征非常重要。
