Choroidal Nevus with Retinal Invasion in 8 Cases

Purpose: Choroidal nevus can cause overlying chronic retinal pigment epithelium (RPE) degenerative features, but frank retinal invasion is exquisitely rare. Procedures: This is a retrospective review of 8 cases of choroidal nevus with retinal invasion with evaluation of clinical and imaging features. Results: At the time of diagnosis of choroidal nevus with retinal invasion, mean patient age was 65 years. Mean tumor basal diameter was 7 mm, and mean thickness was 2.3 mm. Retinal invasion was ophthalmoscopically visible in all eyes. Related features included drusen (n = 4/8) and RPE fibrous metaplasia (n = 2/8). Overlying lipofuscin, subretinal fluid, RPE detachment, and retinal edema were absent. On B-scan ultrasonography, the lesion was dome-shaped (n = 7/7) and echo-dense (n = 6/7). Optical coherence tomography demonstrated outer retinal invasion (n = 8/8) with additional inner retinal invasion (n = 3/8). The tissue was hypoautofluorescent at the site of invasion (n = 6/7). Over a mean follow-up of 40 months, tumor enlargement was detected in 2 eyes and managed with observation (< 1 mm enlargement) or plaque radiotherapy (5 mm enlargement). Nevus hypoautofluorescence was correlated with nevus stability (p = 0.035). Conclusion: Retinal invasion of the choroidal nevus is rare. In this series of 8 cases, only 1 demonstrated transformation to melanoma over a mean interval of 40 months. Long-term monitoring of such lesions is warranted.