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Choroidal amelanotic tumours: clinical differentiation of benign from malignant lesions in 5586 cases
  1. R Joel Welch,
  2. Jennifer H Newman,
  3. Stephanie E Honig,
  4. Eileen L Mayro,
  5. Mark McGarrey,
  6. Alexander E Graf,
  7. Evan B Selzer,
  8. Luis A Acaba-Berrocal,
  9. Sean P Considine,
  10. Kunal Malik,
  11. Jerry A Shields,
  12. Carol L Shields
  1. Oncology Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Carol L Shields, Wills Eye Institute, Philadelphia, PA 19107, USA; carolshields{at}


Purpose To investigate demographics and clinical features of patients with amelanotic choroidal tumours.

Design Retrospective analysis.

Methods Comparison of demographic and clinical features of various amelanotic choroidal tumours based on stratification by patient age, sex and tumour diameter. Included were all patients with amelanotic choroidal tumours evaluated on the Ocular Oncology Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA, over a 45-year time period.

Results A total of 5586 amelanotic choroidal tumours in 4638 eyes of 4441 patients were included with a mean age at presentation of 58 years (median 60, range 0.1–100 years). Most patients were white (95%), female (56%) and with unilateral lesion (96%). By comparison, amelanotic melanoma presented at a younger mean age (57 years) compared with metastasis (60 years, p<0.001), nevus (61 years, p<0.001), lymphoma (65 years, p<0.001), sclerochoroidal calcification (70 years, p<0.001) and peripheral exudative haemorrhagic chorioretinopathy (80 years, p<0.001). Melanoma presented at an older mean age compared with osteoma (30 years, p<0.001), granuloma (42 years, p<0.001), haemangioma (49 years, p<0.001) and inflammatory choroidal lesions (49 years, p<0.001). Differences in race and sex were also seen between the various amelanotic choroidal lesions. With few exceptions, amelanotic melanoma had significantly larger basal diameter, greater thickness, more frequent association with subretinal fluid and more often ultrasonographically hollow, compared with other amelanotic choroidal lesions.

Conclusion Understanding the demographic and clinical features of amelanotic choroidal melanoma and other amelanotic lesions could lead to an earlier and more accurate diagnosis.

  • choroid
  • amelanotic
  • non-pigmented
  • melanoma
  • metastasis
  • haemangioma
  • nevus
  • diagnosis
  • tumour

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  • Contributors CLS is the corresponding author. RJW, JAS and CLS were responsible for study conception, study design and data interpretation. RJW and KM were responsible for data analysis. All 12 co-authors (RJW, JHN, SEH, ELM, MM, AEG, EBS, LAA-B, SPC, KM, JAS and CLS) were responsible for data acquisition. All 12 co-authors were responsible for drafting the work or revising it critically for important intellectual content. All 12 co-authors had final approval of the version to be published. All 12 co-authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding Support provided by the Eye Tumor Research Foundation, Philadelphia, Pennsylvania, USA (JAS and CLS). CLS, MD, 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.

  • Disclaimer The funders had no role in the design and conduct of the study, in the collection, analysis and interpretation of the data, or in the preparation, review or approval of the manuscript.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was provided by the Institutional Review Board of Wills Eye Hospital and the analysis adhered to the tenets of the Declaration of Helsinki.

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

  • Data sharing statement Data are available upon request.

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