Choroidal Nevus

Choroidal Nevus
SYMPTOMS Typically asymptomatic
Choroidal nevi at the macula can cause a decrease in VA due to RPE and photoreceptor degeneration from compression of the choriocapillaris
Choroidal nevi at the posterior pole can cause a visual field defect due to RPE and photoreceptor degeneration from compression of the choriocapillaris
SIGNS Flat (< 2mm thick) | Gray/Green/Brown in color (May also be amelanotic 6-10% of the time) | Usually 1-5mm in diameter Smooth regular to slightly irregular margins | Indistinct borders |Presence of drusen and RPE disruption
WORK-UP Full eye exam with dilation | OCT | OCT-Angiography | Fundus autofluorescence | Fluorescein angiography | ICG | Fundus photos | Infrared photos | B-scan ultrasound
TREATMENT Wear sunglasses/UV protection outside. No treatment. Monitor
FOLLOW-UP Upon initial diagnosis, monitor in 6 months (or sooner if more suspicious). If stable, monitor in 1 year
ADDITIONAL LAB | TESTS None. If a patient presents with a halo choroidal nevus or reverse halo choroidal nevus, get a dermatological consult
ETIOLOGY Benign neoplasm of melanocytes that involves the outer layers of the choroid (Originates in the outer choroid and compresses inward toward the choriocapillaris)
DIFFERENTIAL DX Choroidal melanoma, CHRPE, Choroidal metastasis, Choroidal hemangioma
NOTES Occurs in 5-10% of the general population
Precursor cells are typically present at a young age but proliferation of pigment occurs later in life
Choroidal nevi rarely enlarge or change (only 3-4% of the time)
1 out of every 8,845 cases of choroidal nevi can become malignant (0.0001%) This risk increases to 0.78% if a patient is over the age of 89 years old
Halo nevus: Make up 5% of all choroidal nevi. Surrounded by a circular band of depigmentation (degeneration of altered melanocytes). May be a marker of an underlying cutaneous melanoma, dermatological halo nevi, and vitiligo. Patient should get a dermatological consult (Can also see a reverse halo nevus)
Posted in Choroid, Ocular Conditions