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Choroidal nevi at the macula can cause a decrease in VA due to RPE and photoreceptor degeneration from compression of the choriocapillaris
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Choroidal nevi at the posterior pole can cause a visual field defect due to RPE and photoreceptor degeneration from compression of the choriocapillaris
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SIGNS
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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
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WORK-UP
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Full eye exam with dilation | OCT | OCT-Angiography | Fundus autofluorescence | Fluorescein angiography | ICG | Fundus photos | Infrared photos | B-scan ultrasound
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TREATMENT
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Wear sunglasses/UV protection outside. No treatment. Monitor
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FOLLOW-UP
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Upon initial diagnosis, monitor in 6 months (or sooner if more suspicious). If stable, monitor in 1 year
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ADDITIONAL LAB | TESTS
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None. If a patient presents with a halo choroidal nevus or reverse halo choroidal nevus, get a dermatological consult
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ETIOLOGY
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Benign neoplasm of melanocytes that involves the outer layers of the choroid (Originates in the outer choroid and compresses inward toward the choriocapillaris)
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DIFFERENTIAL DX
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Choroidal melanoma, CHRPE, Choroidal metastasis, Choroidal hemangioma
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NOTES
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Occurs in 5-10% of the general population
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Precursor cells are typically present at a young age but proliferation of pigment occurs later in life
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Choroidal nevi rarely enlarge or change (only 3-4% of the time)
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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
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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)
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