From the Guidelines
Ocular nevi typically don't require treatment as most are benign and remain stable throughout life. According to the most recent evidence, regular monitoring by an ophthalmologist is the standard approach, with photographs taken at each visit to document any changes in size, shape, or color 1. If an ocular nevus shows suspicious changes such as rapid growth, unusual pigmentation, or begins causing symptoms, further evaluation with ultrasound, optical coherence tomography (OCT), or fluorescein angiography may be recommended.
Key Considerations
- The risk of malignant transformation is low (about 1 in 8,000 for choroidal nevi), but certain features like thickness greater than 2mm, orange pigmentation, subretinal fluid, and proximity to the optic disc increase this risk, making regular monitoring essential for early detection of any concerning changes.
- Choroidal nevi, the most common type, are typically observed every 6-12 months, while conjunctival nevi may be surgically removed if they cause discomfort or for cosmetic reasons.
- In rare cases where malignant transformation to melanoma is suspected, treatment options include laser photocoagulation, radiation therapy (brachytherapy or proton beam therapy), or surgical excision, as noted in the context of choroidal naevus and melanoma 1.
Treatment Approach
- Regular checks are recommended for naevi, with a focus on monitoring for any changes that may indicate malignant transformation.
- Treatment for choroidal melanoma may involve brachytherapy, proton therapy, or enucleation based on staging, and intravitreal anti-VEGF injections in case of neovascularization, or sometimes photodynamic therapy in case of serous SRF leaking from naevus without neovascularization 1.
From the Research
Ocular Nevus Treatment Options
- The treatment of ocular nevi can vary depending on the type and location of the nevus, as well as the patient's overall health 2, 3, 4, 5, 6.
- For conjunctival nevi, observation and photo documentation are often recommended due to the low risk of transformation to malignant melanoma 2, 5.
- Laser therapy, including quality-switched lasers and argon laser photoablation, has been shown to be a safe and effective treatment for pigmented lesions, including ocular nevi 3, 4, 6.
- Focal laser photocoagulation has been used to treat leaking choroidal nevi, with successful resolution of subretinal fluid and improvement in vision 4.
- Argon laser photoablation has been used to remove superficial conjunctival nevi, with complete removal of the nevus in 81% of cases and no significant complications 6.
Considerations for Treatment
- The decision to treat an ocular nevus should be made on a case-by-case basis, taking into account the patient's individual circumstances and the potential risks and benefits of treatment 2, 3, 4, 5, 6.
- Regular follow-up and monitoring are important to detect any changes in the nevus and to ensure that treatment is effective 2, 5.
- The use of laser therapy and other treatments should be guided by the principles of selective photothermolysis, which aims to minimize adverse effects and maximize effectiveness 3.