Clinical parameters predictive of enlargement of melanocytic choroidal lesions

The authors followed up 197 melanotic choroidal lesions (62 categorised as benign naevi, 76 classified as suspicious naevi, 41 diagnosed as dormant melanomas, and 18 categorised as active melanomas) left untreated after their initial clinical documentation. Thirty-nine of these lesions enlarged during a five-year follow-up interval (cumulative proportion of lesions that enlarged = 26.2% by Kaplan-Meier method). Individual clinical parameters predictive of lesion enlargement (p less than 0.01) included larger size of the lesion, especially lesion thickness, presence of retinal detachment, location of the lesion's posterior margin within 2 disc diameters of the optic disc, presence of symptoms, and presence of orange pigment clumps on the lesion's surface. The best combination of these parameters for prediction of lesion enlargement, as identified by multivariate Cox regression analysis, consisted of thickness of the lesion, retinal detachment, and symptoms. The five-year incidence of lesion enlargement for patients with none of these prognostic parameters was 5.8%, while that for patients with all three unfavourable parameters simultaneously was 90.6%.