During, “Punt It or Confront It: A Guide to Identify Lesions of the Choroid,” Robert Yacoub, OD, FAAO, discussed distinguishing between benign and malignant choroidal lesions. The lecture occurred yesterday at 11 a.m.

“There are certain sight-threatening ocular diseases that we, as optometrists, just cannot miss. A choroidal melanoma would certainly fit that bill,” he said of his lecture. “[I hope] my fellow optometrists will be able to differentiate between benign choroidal lesions, such as a choroidal nevus, from malignant choroidal lesions, such as a choroidal melanoma.”

The nine red flags of a choroidal melanoma:

1. Thickness
If the thickness of the choroid is greater than 2.0 mm, it’s more likely a choroidal melanoma. The average choroidal melanoma is 5.5 mm thick, Dr. Yacoub explained.

2. Subretinal fluid
The presence of subretinal fluid is more likely to be seen in a choroidal melanoma. What’s more, it is a major risk factor for metastasis, pointed out Dr. Yacoub.

3. Visual symptoms
Blurred vision (visual acuity typically 20/50 or worse), loss of vision, scotomas, progressive visual field loss, flashes, floaters, and eye pain are more indicative of a choroidal melanoma, Dr. Yacoub asserted.

4. Lipofuscin accumulation
Lipofuscin accumulation in the retina pigment epithelium (RPE) is more likely to be associated with a choroidal melanoma because tumors tend to be more metabolically active, Dr. Yacoub pointed out.

5. Optic disc margin proximity
A choroidal lesion in contact with the optic disc margin or within 3 mm of the optic disc margin is indicative of a choroidal melanoma.

6. Large basal diameter
A choroidal lesion with a basal diameter greater than 5 mm is more likely to be a choroidal melanoma. Keep in mind that the average basal diameter of a choroidal nevus is 1.25 mm.

7. Growth in less than two years
A choroidal lesion that increases in size in less than two years is indicative of a choroidal melanoma.

8. Solid mass/acoustic hollow internal area
A choroidal lesion that appears as a solid mass with an acoustic hollow internal area that is hypoechoic to low hyperechoic is likely a choroidal melanoma. OM