definitive mushroom shape with overhang)Ģ = Confluent (i.e. The MOLES scoring system for categorising melanocytic choroidal tumours according to likelihood of malignancy Indicatorġ = Incipient (erosion through RPE) / uncertain)Ģ = Present (i.e. local pathways defining referral criteria based on MOLES have been developed and should be followed where available MOLES score ≥3 is defined as “probable melanoma” Alternatively, use the MOLES scoring system.thickness greater than 1.5mm (or LBD greater than 6mm).thickness greater than 2.0mm (or LBD greater than 7mm).patients with a suspicious melanocytic choroidal tumour having.Urgent (within two weeks, in accordance with the Suspected CANcer pathway, SCAN) referral to ophthalmologist (RCOphth guidance): MOLES has been validated in an ocular oncology setting and shows a high sensitivity for indicating malignancy.Ī3 (modified): Probable melanoma.
Tumours are diagnosed according to the sum of these five scores as: Each feature is scored 0, 1, or 2 depending on whether they are absent, borderline/uncertain, or present. the MOLES scoring system (see below) scores five features of melanocytic choroidal tumours that are suggestive of malignancy: mushroom shape, orange pigment, large size, enlarging tumour and sub-retinal fluid.vitreous haemorrhage is rare, occurring only if the tumour has perforated the retina.These tumours are aggressive and often extend extra-ocularly by the time of diagnosis with a wide base but minimal thickening). about 5% of choroidal melanomas are diffuse (i.e.If they break through Bruch’s membrane and RPE, they can develop a mushroom (‘collar stud’) shape, which is almost pathognomic for melanoma larger choroidal melanomas are dome-shaped, with more extensive serous retinal detachment.documented growth (which requires sequential colour photography).subretinal fluid, most easily seen on OCT.clumps of orange pigment (which are hyper-autofluorescent).there is a size overlap between choroidal naevi and choroidal melanomas with the following relative frequencies:.larger size (i.e., thickness >2 mm and/or largest basal diameter (LBD) >6mm ).small choroidal melanomas are distinguished from naevi by:.the CHRPE lesion may (extremely rarely) develop low-grade adenocarcinoma on its surface.may show a narrow non-pigmented line at margins of lesion.solitary, flat, well-demarcated deeply-pigmented lesion (but may contain discrete non-pigmented areas called lacunae).drusen indicate chronicity so that their absence over a domed lesion is suspicious.atypical naevi are larger and dome-shaped, with or without drusen and/or traces of sub-retinal fluid orange pigment absent.typical naevi are small, flat and grey (though some are amelanotic), with a featureless surface and no sub-retinal fluid.outcome poor once metastasis occurs 1 year survival in 10-15%.genetic changes (chromosome 3 loss or BAP1 mutation).cell type and histopathological features.detection and treatment at earliest stage improves prognosis.life-threatening ocular malignancy (risk of metastatic disease).rare in Asians and very rare in Africans.1.3-8.6 cases per million per year in European-derived populations.
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