Is Tumour Thickness Measurement Required for MOLES Scoring of Melanocytic Choroidal Tumours?

Jared Ching; Lamis AlHarby; Mandeep S Sagoo; Bertil Damato

doi:10.1159/000529862

Is Tumour Thickness Measurement Required for MOLES Scoring of Melanocytic Choroidal Tumours?

Ocul Oncol Pathol. 2023 Aug;9(1-2):40-47. doi: 10.1159/000529862. Epub 2023 Apr 10.

Authors

Jared Ching^{1

2}, Lamis AlHarby^{1

3}, Mandeep S Sagoo^{1

3}, Bertil Damato^{1

3

4}

Affiliations

¹ Ocular Oncology Service, Moorfields Eye Hospital, London, UK.
² John van Geest Centre for Brain Repair, University of Cambridge, Cambridge, UK.
³ NIHR Biomedical Research Centre for Ophthalmology, University College London Institute of Ophthalmology, London, UK.
⁴ Nuffield Laboratory of Ophthalmology, University of Oxford, John Radcliffe Hospital, Oxford, UK.

Abstract

Introduction: It can be challenging to distinguish between choroidal naevi and melanomas in the community setting, particularly without access to ultrasonography (US), required to measure the thickness of melanocytic choroidal tumours. We aimed to determine whether thickness measurement is required for MOLES scoring of melanocytic choroidal tumours.

Methods: The dataset of a recent MOLES evaluation was reviewed. Patients were selected for the present study if their MOLES tumour size category was determined by tumour thickness measured with US. The largest basal tumour diameter and tumour thickness were then measured from ultra-widefield fundus images and optical coherence tomography (OCT) images, respectively.

Results: The tumour size category was determined by tumour diameter in 203/222 (91.4%) with no influence of tumour thickness. The tumour thickness influenced the MOLES score in 19/222 (8.6%) patients. In 11/19 patients with OCT measurements of tumour thickness, the US measurement exceeded the OCT by more than 25% in 5 patients, more than 50% in 2 patients, and more than 75% in 1 patient. As a result, the revised tumour thickness based on OCT determined the size category in 4/216 (1.8%) patients. The ultra-widefield fundus images measurements increased the diameter score by 1 in 5 patients. As a result, the revised tumour thickness determined the size category in 4/216 (1.8%) patients. If both the revised diameter and thickness scores were considered, the MOLES score reduced in 4 patients. If both the diameter and thickness scores were considered, the MOLES score reduced in 5 and increased in 1. Only 0.94% (2/211) of melanocytic choroidal tumours assessed with MOLES when using Optos ultra-widefield fundus images diameter and OCT to measure tumour diameter and thickness, respectively, required a change in management from a reduction in MOLES score from 1 to 0.

Discussion/conclusion: This study suggests that the MOLES category for size is influenced more by the tumour diameter, if it can be measured accurately, than by the thickness. This study suggests ignoring tumour thickness if this cannot be measured accurately with OCT, unless the tumour has a mushroom shape.

Keywords: Choroidal melanoma; Choroidal naevus; MOLES score; Tumour thickness.

Grants and funding

The publication of this article has been enabled by a grant from Moorfields Eye Charity [GR001621]. The research was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.