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. 2021 Sep;7(4):294-302.
doi: 10.1159/000511363. Epub 2021 Mar 15.

Distinguishing Choroidal Nevi from Melanomas Using the MOLES Algorithm: Evaluation in an Ocular Nevus Clinic

Lamis Al Harby  1   2   3 , Mandeep S Sagoo  1   2   3 , Roderick O'Day  1 , Gordon Hay  1   2   3 , Amit K Arora  1   2 , Pearse A Keane  2   3 , Victoria M-L Cohen  1   2 , Bertil Damato  1   4
Affiliations

Distinguishing Choroidal Nevi from Melanomas Using the MOLES Algorithm: Evaluation in an Ocular Nevus Clinic

Lamis Al Harby et al. Ocul Oncol Pathol. 2021 Sep.

Abstract

Objective: The aim of this study was to determine the sensitivity and specificity of the MOLES scoring system in differentiating choroidal melanomas from nevi according to Mushroom shape, Orange pigment, Large tumor size, Enlarging tumor, and Subretinal fluid (SRF).

Methods: Color photographs, fundus-autofluorescence images, and optical coherence tomography of 222 melanocytic choroidal tumors were reviewed. Each MOLES feature was retrospectively scored between 0 and 2 and tumors categorized as "common nevus," "low-risk nevus," "high-risk nevus," and "probable melanoma" according to the total score. MOLES scores were compared with the experts' diagnosis of melanoma.

Results: The MOLES scoring system indicated melanoma in all 81 tumors diagnosed as such by ocular oncologists (100% sensitivity) and nevus in 135 of 141 tumors given this diagnosis by these experts (95.7% specificity). Of the 6 tumors with discordant diagnoses, 4 had basal diameters exceeding 6 mm, all with SRF and/or orange pigment, and 2 small tumors showed either significant SRF with traces of orange pigment, or vice versa.

Conclusions: The MOLES system for diagnosing melanocytic choroidal tumors compares well with expert diagnosis but needs to be evaluated when deployed by ophthalmologists and community optometrists in a wide variety of working environments.

Keywords: Choroidal moles; Choroidal nevus; Choroidal tumor; Melanoma; Ophthalmic oncology.

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Conflict of interest statement

The authors have no conflicts of interest to report. This manuscript has not previously been submitted for publication. None of the authors have any financial disclosures to declare.

Figures

Fig. 1
Fig. 1
OCTs and fundus autofluorescence images of 6 tumors with a MOLES score >2 and diagnosed by experts as nevus. a–c Case 141 (MOLES = 00201 = 3), with basal diameter >4 DD and trace SRF. d–f Case 142 (MOLES = 00201 = 3), with basal diameter >4 DD and trace SRF. g–i Case 147 (MOLES = 01200 = 3), with trace orange pigment and basal diameter >4 DD. j–l Case 159 (MOLES = 00202 = 4), with basal diameter >4 mm and significant SRF. m–o Case 148 (MOLES = 01102 = 4), with trace orange pigment, thickness >1 mm and significant SRF. p–r Case 153 (MOLES = 02101 = 4), with confluent orange pigment, basal diameter 3 mm, and trace SRF.
See this image and copyright information in PMC

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