Malignant transformation of choroidal nevus according to race in 3334 consecutive patients.

Purpose: To evaluate choroidal nevus demographics, clinical features, imaging features, and the rate of transformation into melanoma by race. Methods: In this observational case series,: There were 3334 participants (3806 choroidal nevi) at a single tertiary-referral center evaluated between January 2, 2007, and August 7, 2017. Retrospective chart and multimodal imaging review was performed. Patient demographics, tumor features, and outcomes were compared between different races using Chi-squared test, Fisher's exact test, t-test, and analysis of variance. The main outcome measure was clinical features of choroidal nevus and the rate of transformation into melanoma by race. Results: Of the 3334 patients, there were Caucasian (n = 3167, 95%) and non-Caucasian (n = 167, 5%). The non-Caucasian races included African-American (n = 27, <1%), Hispanic (n = 38, <1%), Asian (n = 15, <1%), Asian Indian (n = 2, <1%), Middle Eastern (n = 4, <1%), and unknown (n = 83, 3%). By comparison (Caucasian versus vs. non-Caucasian), there were differences in the mean age at presentation (61 vs. 56 years,P < 0.0001), female sex (63% vs. 52%,P < 0.01), dysplastic nevus syndrome (<1% vs. 1%,P < 0.01), and previous cutaneous melanoma (5% vs. 1%,P= 0.03). A comparison of tumor features revealed differences in presence of symptoms (12% vs. 20%,P < 0.01) and ≥3 nevi per eye (3% vs. <1%,P= 0.04). A comparison of imaging features showed no differences. A comparison of outcome of nevus transformation into melanoma revealed no difference (2% vs. 3%,P= 0.29). However, of those nevi exhibiting growth to melanoma, ultrasonographic hollowness was less frequent in Caucasians (29% vs. 67%,P= 0.04). Conclusion: In this analysis of 3334 patients with choroidal nevus, we found differences in the mean age of presentation, sex, dysplastic nevus syndrome, previous cutaneous melanoma, presence of symptoms, and multiplicity of nevus per eye by race. However, there was no difference in the rate of transformation into melanoma by race.

Prevalence and characteristics of choroidal nevi: the Australian National Eye Health Survey.

IMPORTANCE: Choroidal nevi are a common incidental finding on fundus examination. The National Eye Health Survey (NEHS, 2015-2016) provides an up-to-date estimate of the prevalence of choroidal nevi in non-Indigenous and Indigenous Australian adults. BACKGROUND: To describe the prevalence and characteristics of choroidal nevi among non-Indigenous and Indigenous Australian adults. DESIGN: Population-based cross-sectional study. PARTICIPANTS: This study included 3098 non-Indigenous Australians (aged 50-98 years) and 1738 Indigenous Australians (aged 40-92 years) living in 30 randomly selected sites, stratified by remoteness. METHODS: Choroidal nevi were graded from retinal photographs using standard protocols. MAIN OUTCOME MEASURES: Prevalence of choroidal nevi. RESULTS: In the non-Indigenous population aged 50 years and over, the weighted prevalence of choroidal nevi was 2.1% (95% CI: 1.4, 3.3). Among Indigenous Australians aged 40 years and over, the weighted prevalence of choroidal nevi was 0.68% (95% CI: 0.4, 1.3). The average maximum diameter, surface area and distance from the disc of the choroidal nevi was 1730 µm, 2 766 800 µm2 and 3400 µm, respectively. After multivariate adjustments, Indigenous participants (OR = 0.28, P = 0.01) and those of older age (OR = 0.79 per 10 years, P = 0.02) were less likely to have choroidal nevi. Choroidal nevus was not the primary cause of vision loss in any participant. CONCLUSIONS AND RELEVANCE: Choroidal nevi were relatively infrequent among NEHS participants, however non-Indigenous Australians had a significantly higher prevalence than Indigenous Australians. Choroidal nevi did not affect visual acuity and the majority were small.

Choroidal Nevus in the United States Adult Population: Racial Disparities and Associated Factors in the National Health and Nutrition Examination Survey.

PURPOSE: To describe the prevalence of choroidal nevus in the US population and identify possible associated factors. DESIGN: Cross-sectional study. PARTICIPANTS: A total of 5575 participants aged ≥40 years from the 2005-2008 National Health and Nutrition Examination Survey (NHANES) who underwent retinal imaging examination. METHODS: Predictor variables included a spectrum of demographic, ophthalmic, dermatologic, systemic, socioeconomic, or occupational factor variables available in NHANES. MAIN OUTCOME MEASURES: Choroidal nevus on retinal imaging. RESULTS: The prevalence of choroidal nevus was 4.7% overall and increased with age (4.7%, 3.1%, 5.4%, 6.6%, and 7.5% in subjects aged 40-49, 50-59, 60-69, 70-79, and ≥80 years, respectively). The prevalence was 5.0% in men, 4.4% in women, 5.6% in whites, 2.7% in Hispanics, 0.6% in blacks, and 2.1% in others. After adjusting for age and race, the odds of choroidal nevus were 10-fold higher in whites than in blacks, 5-fold higher in Hispanics than in blacks, 4-fold higher in others than in blacks, and 2-fold higher in whites than in Hispanics. Choroidal nevus was associated with hypertension (odds ratio [OR], 1.40; 95% confidence interval [CI], 0.99-1.98); psoriasis (OR, 3.90; 95% CI, 1.57-9.66); lower high-density lipoprotein (OR, 0.99; 95% CI, 0.98-0.99); higher uric acid (OR, 1.13; 95% CI, 1.04-1.22); working in installation, maintenance, or repairs (OR, 1.42; 95% CI, 1.03-1.96); and having never worked (OR, 1.56; 95% CI, 1.03-2.37; P = 0.04). There was no association with visual symptoms, visual functioning, visual acuity, refractive error, visual field, diabetic retinopathy, age-related macular degeneration, or elevated cup-to-disc ratio on retinal imaging. There was no association with skin melanoma, other cancers, lung/liver/kidney/thyroid disease, alcohol/drug use, income/education, hemoglobin A1C, C-reactive protein, lactate dehydrogenase, electrolytes, or urine albumin. CONCLUSIONS: Among US adults, the prevalence of choroidal nevus located within two 45° areas centered on the macula and optic disc is 4.7%. The prevalence increases with age, is highest among whites (5.6%), is lowest among blacks (0.6%), and has been previously under-recognized among Hispanics (2.7%). Extrapolating to the entire fundus, the true prevalence of choroidal nevus is even higher but difficult to accurately estimate. Possible associations with cardiovascular, renal, autoimmune, and occupational risk factors warrant further investigation.

Prognosis of choroidal melanoma and the result of ruthenium brachytherapy combined with transpupillary thermotherapy in Korean patients.

BACKGROUND/AIMS: To evaluate the clinical features and prognosis of choroidal melanoma in Korean patients and the results of treatment with ruthenium (Ru) 106 plaque brachytherapy. METHODS: The medical charts of 111 patients diagnosed with choroidal melanoma who underwent Ru brachytherapy with trans-pupillary thermotherapy or local resection (61 patients) or who underwent other treatments (26 primary enucleations, 22 γ-knife radiotherapies and two lamellar sclerouvectomies) were reviewed retrospectively. RESULTS: The mean largest basal diameter (LBD) was 11.4±3.2 mm and the mean apical height was 7.8±2.9 mm. Compared with the collaborative ocular melanoma study, mean tumour height was skewed toward higher values (6.2 vs 4.8 in medium tumours, p<0.0001; 10.9 vs 9.5 mm in large tumours, p=0.034) and the LBD in large tumours was skewed toward smaller values (13.6 vs 17.3, p<0.0001). The estimated 5-year metastasis-free rate was 73.9% and the disease-specific survival rate was 84.6%. For the 61 patients that were treated with Ru brachytherapy, the 5-year metastasis-free and disease-specific survival rates were 79.0% and 87.7%, respectively, and the 5-year incidence of enucleation was 25.4%. The mean tumour regression at 6, 12 and 18 months after brachytherapy was 80.2%, 73.1% and 69.2%, respectively. CONCLUSIONS: Choroidal melanomas in Korean patients tend to grow vertically with a relatively large apical height and a small LBD. The prognosis of choroidal melanomas overall as well as prognosis after Ru brachytherapy were similar to those seen in previous studies with Caucasian patients. The enucleation rate after brachytherapy seems to be higher in Korean patients, for which a greater initial tumour height seems to be partly responsible.

Prevalence and characteristics of choroidal nevi: the multi-ethnic study of atherosclerosis.

OBJECTIVE: To describe the prevalence of choroidal nevi in 4 racial or ethnic groups (white, black, Hispanic, and Chinese) in the United States. DESIGN: Cross-sectional study. PARTICIPANTS: Participants of the second examination of the Multi-Ethnic Study of Atherosclerosis (MESA), involving 6176 persons 44 to 84 years of age without clinical cardiovascular disease at baseline selected from 6 United States communities. METHODS: Fundus images were taken using a 45° digital camera through dark-adapted pupils and were graded for choroidal nevi using the modified Wisconsin Age-Related Maculopathy Grading System and the Blue Mountains Eye Study protocol. MAIN OUTCOME MEASURES: Choroidal nevi. RESULTS: The overall prevalence of choroidal nevi in the whole cohort was 2.1%, with prevalences higher in whites (4.1%) than blacks (0.7%), Hispanics (1.2%), and Chinese (0.4%; P<0.001 for any differences among groups). The lowest prevalence of choroidal nevi occurred in those 75 to 84 years of age. The nevi were subfoveal in 4% of eyes with nevi and were not associated with a decrease in visual acuity. Characteristics of the nevi (size, shape, location, color, drusen on surface) did not differ among racial or ethnic groups. With the exception of associations with higher C-reactive protein levels (odds ratio [OR] per mg/dl on the logarithmic scale, 1.23; 95% confidence interval [CI], 1.06-1.43; P = 0.01) and lower systolic blood pressure (OR per 10 mmHg, 0.90; 95% CI, 0.82-0.99; P = 0.04), choroidal nevi were not associated with other potential risk factors (e.g., gender, smoking status, alcohol consumption, lipid levels, coagulation factors, or kidney disease). CONCLUSIONS: Low prevalences of choroidal nevi were found in the 4 groups participating in the MESA cohort, with whites having higher prevalence than the other racial or ethnic groups. The higher prevalence in whites than in other groups was not explained by any of the factors studied. When choroidal nevi were present, their characteristics did not differ among racial or ethnic groups. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Clinical and cytogenetic characteristics of choroidal melanoma in Vietnamese Asians.

PURPOSE: To report the clinical and cytogenetic characteristics of choroidal melanoma in Vietnamese Asians. METHODS: In three Vietnamese Asians with choroidal melanoma, transscleral fine needle aspiration biopsy (FNAB) was performed immediately before iodine-125 brachytherapy. Biopsy was examined for cytopathology, fluorescence in situ hybridization (FISH) for the centromere of chromosome 3, and analyzed by 250K whole genome Mapping Array and U133 plus 2.0 Expression Array. RESULTS: Three Vietnamese Asian men (50, 59, and 30 years of age) with clinical diagnosis of choroidal melanoma and no evidence of metastasis had FNAB immediately before Iodine-125 brachytherapy. Cytopathology showed heavily pigmented cells suggestive of or consistent with melanoma. Mapping Array and Expression Array revealed cytogenetic aberrations and gene expression profiles characteristic of choroidal melanoma. One patient (Case 2) with chromosome 3 loss and chromosome 8q gain developed biopsy-proven liver metastasis three years after brachytherapy. One patient (Case 1) with chromosome 6p, 9q and 17q gain and a second patient (Case 3) with 6p, 8q and 9q gains and losses in 6q and 8p have had no evidence of metastasis three years after brachytherapy. CONCLUSIONS: In this series of Vietnamese Asians with heavily pigmented choroidal melanoma, the clinical characteristics, cytogenetic aberrations and gene expression profiles were similar to characteristics in other ethnic/racial groups and the cytogenetic aberration of chromosome 3 loss was associated with the development of liver metastasis.

Photodynamic therapy for symptomatic circumscribed macular choroidal hemangioma in Chinese patients.

PURPOSE: To evaluate the efficacy and safety of photodynamic therapy (PDT) for macular circumscribed choroidal hemangioma in Chinese patients. DESIGN: Retrospective, consecutive, noncomparative case series. METHODS: Twenty-five eyes (25 patients) with macular circumscribed choroidal hemangioma, 18 subfoveal and 7 perifoveal, with vision impairment attributable to subfoveal fluid and retinal detachment underwent visual acuity testing, fundus fluorescein angiography, ultrasonography, and optical coherence tomography (OCT) examinations to evaluate the efficacy and safety of PDT treatment. PDT was performed with a standard concentration of verteporfin and intravenous injection time. Laser was used at 50 J/cm² for 83 seconds on subfoveal and 75 J/cm² for 125 seconds on perifoveal lesions. More than 1 spot was used for large lesions and spots overlapped only outside the fovea. RESULTS: The mean follow-up time was 35.5 ± 15 months. All patients were treated with 1 session except in 2 subfoveal cases. The mean best-corrected visual acuity (BCVA) increased from 0.09 ± 0.11 to 0.31 ± 0.37 (P < .01) and 11 patients (44%) had their vision improve over 4 lines. The remaining 14 patients (56%) had stabilized vision with the retina reattached. The mean thickness of the hemangioma before the treatment was 3.2 ± 0.9 mm and decreased to 1.3 ± 1.0 mm post treatment (P < .01), with complete regression of tumor in 7 cases (28%). CONCLUSIONS: PDT with individualized laser parameters for macular circumscribed choroidal hemangioma is effective and safe, leading to improved or stabilized BCVA as a result of tumor shrinkage and the resolution of the subretinal fluid.

Prevalence and characteristics of choroidal nevi in an Asian vs white population.

OBJECTIVE: To describe the prevalence and characteristics of choroidal nevi in an Asian population and compare this with findings from a white population. METHODS: The Singapore Malay Eye Study (SiMES) examined a population-based, cross-sectional, age-stratified, random sample of 3280 Malay persons (78.7% participation rate) aged 40 to 80 years living in Singapore. Comprehensive examination of participants included bilateral retinal photography. Choroidal nevi were graded from photographs using the Blue Mountains Eye Study (BMES) protocol. RESULTS: The person-specific prevalence of choroidal nevi was 1.4%, with 50 nevi found in 45 participants. This is lower than the 6.5% prevalence seen in white persons in the BMES. However, characteristics of nevi in Malay persons in the SiMES were similar to those of white persons in the BMES by size (SiMES, 1.27 mm; BMES, 1.25 mm; P = .35), shape (P = .58), color (P = .39), location within posterior pole or periphery (P = .30), and nevus margin proximity to the optic disc (P = .29). Features previously identified as indicating growth or malignant potential (including diameter >6 mm, posterior margin touching optic disc, orange pigment, pigment clumping, and retinal edema) were not found in this sample. CONCLUSION: Choroidal nevi were detected in 1.4% of Malay persons. There were no significant racial or ethnic differences in nevi characteristics between Malay and white persons.

Choroidal melanoma with extrascleral extension in an Australian Aboriginal man.

Choroidal melanoma is a rare occurrence in pigmented races. Low clinical suspicion of choroidal melanoma may result in diagnostic delay. We present a rare case of choroidal melanoma with extrascleral orbital extension in an Australian Aboriginal man. We are unaware of previous reports of uveal melanoma in Aboriginal Australians and could find no reference to it in a computerized search utilizing Medline.

Choroidal melanoma with oculodermal melanocytosis in Hispanic patients.

PURPOSE: To describe three Hispanic patients with oculodermal melanocytosis and uveal melanoma. METHOD: Case series. RESULTS: Three Hispanic patients with oculodermal melanocytosis and uveal melanoma underwent enucleation. The diagnosis of choroidal melanoma was confirmed by histopathologic examination. CONCLUSION: In the Hispanic population, uveal melanoma can occur in the presence of oculodermal melanocytosis.

Choroidal nevi in a white population: the Blue Mountains Eye Study.

OBJECTIVE: To determine the prevalence, morphologic characteristics, associations, and frequency of features reported to predict growth of choroidal nevi in a large population-based sample. METHODS: A total of 3654 subjects aged 49 to 97 years participating in the Blue Mountains Eye Study had a detailed eye examination, including photography of 6 standard retinal fields. Nevi were graded from photographs. RESULTS: Nevi were present in 6.5% of the population (n = 232), and were distributed equally between eyes. There was a slight decrease in nevus prevalence with increasing age. Nevus prevalence was higher in women than men, but this difference was not statistically significant. The mean nevus diameter was 1.25 mm (SD, 0.72 mm; range, 0.5 to >4.5 mm). Eighty-seven percent of nevi were blue gray and 6% had a hypomelanotic or amelanotic appearance. There were no significant associations between nevi and iris or skin color or sun-induced skin damage, but nevi were significantly less frequent in persons with blond hair. No nevus associations were found with visual impairment, cataract, or glaucoma. Clearly visible drusen were seen on 42% of nevi and were larger and more centrally distributed as nevus size increased. Features previously identified as predicting nevus growth, such as serous elevation and orange or other pigment, were seen rarely. CONCLUSION: Choroidal nevi in the general population are frequent, small, have few features that are commonly reported to indicate potential for growth, and rarely affect visual acuity.

Primary choroidal malignant melanoma occurring in a New Zealand Maori.

PURPOSE/METHOD: A case of a 28-year-old Maori with an aggressive primary choroidal malignant melanoma is presented. RESULTS/CONCLUSION: Melanoma and particularly intra-ocular melanoma is very rare in pigmented races. This is the first reported case in the Maori.

Choroidal melanomas in Hispanic patients.

The initial clinical manifestation and subsequent pathologic characteristics of choroidal melanomas were reviewed in 20 enucleated eyes of Hispanic patients identified between 1974 and 1992. We compared them to 125 choroidal melanomas of randomly selected white patients identified over the same time period. At the time of diagnosis and at subsequent enucleation, the Hispanic patients were younger (P = .002) than the white patients. Eye pain (P = .016), red eye (P = .0002), and tearing (P = .012) were reported more commonly by the Hispanic patients, and on clinical examination the intraocular pressure was higher (P = .001) and more rubeosis iridis was noted (P < .0001) in the Hispanic patients than in the white patients. The tumors of the Hispanic patients were larger in their greatest base dimension (P = .003), and were heavily pigmented compared with those of the white patients (P = .0001). A trend toward less inflammation within the tumor and toward more epithelioid cell type was noted in the Hispanic patients.

Diffuse malignant change in a ciliochoroidal melanocytoma in a patient of mixed racial background.

A 69-year-old man of mixed racial background was discovered to have a large, deeply pigmented mass in his left eye with a history of rapid growth during the previous 6 months. The eye was enucleated, and histopathological examination revealed an epithelioid malignant melanoma arising from a melanocytoma.