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Combination of multimodal imaging features predictive of choroidal nevus transformation into melanoma
  1. Lauren A Dalvin1,2,
  2. Carol L Shields1,
  3. David Arturo Ancona-Lezama1,
  4. Michael D Yu1,
  5. Maura Di Nicola1,
  6. Basil K Williams Jr1,
  7. J Antonio Lucio-Alvarez1,
  8. Su Mae Ang1,
  9. Sean M Maloney1,
  10. R Joel Welch1,
  11. Jerry A Shields1
  1. 1 Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
  2. 2 Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Carol L Shields, Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107, USA; carolshields{at}


Aim To characterise combinations of multimodal imaging risk factors and predictive value for choroidal nevus transformation into melanoma.

Methods This is a retrospective review of multimodal imaging features for 3806 choroidal nevi from 1 January 2007 through 1 January 2017. Kaplan-Meier estimates and Cox regression analyses were used to calculate 5-year percentages of growth to melanoma and HR.

Results Using multimodal imaging, six risk factors predictive of choroidal nevus transformation into melanoma were identified, namely tumour thickness >2 mm, subretinal fluid, symptoms of visual acuity loss to 20/50 or worse, orange pigment, hollow acoustic density and tumour largest basal diameter >5 mm. Kaplan-Meier 5-year estimated tumour growth was found in 1% of nevi with no risk factors, 11% (range 9%–37%) with one factor, 22% (12%–68%) with two factors, 34% (21%–100%) with three factors, 51% (0%–100%) with four factors and 55% (0%–100%) with five factors. HR for growth was 0.1 with no factor, 2.1–7.8 with one factor, 1.8–12.1 with two factors, 4.0–24.4 with three factors, 4.6–170.0 with four factors and 12.0–595.0 with five factors. The highest HR with each combination of two, three, four or five risk factors always included symptoms of visual acuity loss and orange pigment.

Conclusion Six risk factors for choroidal nevus transformation into melanoma by multimodal imaging have been identified. Risk for transformation into melanoma is 1% when no factors are present, and approaches 100% with specific combinations of three or more risk factors. Understanding how combinations of factors influence risk of transformation into melanoma can guide counselling and treatment decisions.

  • choroid
  • nevus
  • melanoma
  • transformation
  • growth
  • risk factors
  • multimodal imaging
  • combination

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  • Presented at Presented in part as the Everett L. Goar Lecture in Houston, TX on September 6, 2018 (CLS).

  • Contributors The authors have contributed by conception of the study with supervision and critical revision of the manuscript (CLS, JAS), data collection (LAD, DAA-L, MDY, MDN, BKW, JAL-A, SMA, SMM, RJW), and drafting of the manuscript (LAD). JAS has had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

  • Funding This research was supported by the Eye Tumor Research Foundation, Philadelphia, Pennsylvania (CLS), an unrestricted grant from Research to Prevent Blindness, New York, New York (LAD), the Heed Ophthalmic Foundation, San Francisco, California (LAD), a grant from the VitreoRetinal Surgery Foundation, Minneapolis, Minnesota (LAD), and a grant from Aura Bioscience, Cambridge, Massachusetts (CLS). Grant numbers are not applicable to these sources of support.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Institutional Review Board/Ethics Committee approval was obtained from Wills Eye Hospital. The study adhered to the tenets of the Declaration of Helsinki and the Health Insurance Portability and Accountability Act.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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