Suspicious choroidal naevi

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The speaker will summarize characteristics of and guidelines for referral of non-suspicious and suspicious choroidal naevi, based on review of literature and personal experience. Recognition and characterisation of choroidal naevi is based on fundus examination with the slit lamp and indirect ophthalmoscope, supplemented with ultrasonography (thickness, acoustic profile), optical coherence tomography (subretinal fluid, thickness) and fundus autofluorescence (subretinal fluid, orange pigment). Large to medium-sized melanomas are readily differentiated from naevi using these methods. The challenge lies in telling small melanomas from naevi. The mnemonic ‘To Find Small Ocular Melanomas’ reminds us to look for tumour Thickness of more than 2 mm, subretinal Fluid, visual Symptoms, Orange pigment and location of the tumour Margin at the optic disc. Each of these risk indicators approximately doubles the likelihood of growth and malignancy, but none of them is specific. Surveillance for growth, a biopsy, or both, may thus be needed after the initial evaluation.

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