Choroidal nevus temporal to the macula

ICD-10 Diagnosis Codes:

D31.31 — Benign neoplasm of right choroid
D31.32 — Benign neoplasm of left choroid


Benign Neoplasm of Choroid


Benign Neoplasm Of Eye


A choroidal nevus is a benign melanocytic lesion of the posterior uveal tract.

Choroidal nevus is a benign tumor caused by proliferation of the melanocytes normally found in the uvea.  

The lesion is characterized by the following clinical features:

  • Usually no change in visual acuity
  • Clearly defined margins
  • Flat or slightly elevated
  • Stable in size over time
  • Overlying drusen
  • Retinal pigment epithelial atrophy
  • Hyperplasia
  • Fibrous metaplasia
  • Subretinal fluid
  • Orange pigment

Structural Damge to the Eye

  • None
  • Subretinal and/or intraretinal fluid 
  • Cystoid retinal edema
  • Choroidal neovascularization

Functional Damage to the Eye

  • None
  • Central and peripheral vision loss secondary to retinal complications

The main goal of the diagnostic evaluation in a patient with choroidal nevus is to accomplish the following:

  • Evaluate tumor location, color, size and thickness
  • Determine visual acuity
  • Obtain baseline fundus photographs
  • Rule out malignant choroidal melanoma

Patient History

The symptoms of choroidal nevus vary from no symptoms to severe visual impairment.  Patients with a large nevus may have mild visual impairment secondary to retinal complications.

Patients with a choroidal nevus may present with any of the following abnormal clinical signs or symptoms:

  • None
  • Central and peripheral vision loss secondary to subretinal fluid

Clinical Appearance of the Retina

DG2246ABa Peripapillary Choroidal Nevus

  • 20/20 visual acuity
  • Medium-sized black lesion adjacent to the optic disc
  • Clearly defined margins
  • No overlying drusen
  • No retinal pigment epithelial atrophy


Fundus Photography

  • Document the size, shape, color, location and height of choroidal nevus
  • Document associated clinical features of choroidal nevus

Retinal Laser Scan

  • Document the presence or absence of subretinal fluid at the macula

B-Scan Ophthalmic Ultrasound

  • Document the presence or absence of ultrasound hollowness within the choroidal nevus
  • Document the height of the choroidal nevus
  • Document the presence or absence of choroidal tissue excavation
  • Follow-up for at least 1.5 years may be necessary to differentiate between a choroidal nevus and a choroidal melanoma
1OSb Childress Dolores_Left_B_1a

A choroidal nevus may be pigmented or non-pigmented. 

Choroidal Melanoma

Risk factors for identification of a small choroidal melanoma (when it might resemble a nevus), have been identified. Documented growth/change of a choroidal nevus over one to two years is a characteristic of malignant transformation.

DG19060ABa Risk Factors that are Predictive of Tumor Growth

  • Thickness greater than 2 mm
  • Subretinal fluid
  • Symptoms of reduced vision or photopsia
  • Orange pigment
  • Tumor margin less than or equal to 3 mm from the optic disc
  • Ultrasound hollowness
  • Absence of surrounding depigmented halo
  • Absence of overlying druse

The treatment of a benign choroidal nevus is determined by its risk of malignant transformation into a choroidal melanoma.

  • Patients with no suspicious features require no treatment
  • After the initial diagnosis, patients should be monitored twice during the first year
  • Subsequently, annual surveillance examinations are recommended as long as the nevus remains stable

It is not common for a choroidal nevus to transform into a malignant melanoma.  The annual rate of malignant transformation is estimated to be 1 in 8,845.  The rate of malignant transformation increases with age and by age 80 the rate increases to 0.78%.

  • A choroidal nevus that has one risk factor for growth has a 3% chance of growth at five years
  • Patients with one or two risk factors should be examined every six months
  • A choroidal nevus with three or more risk factors has a 50% chance of growth at five years and probably represents a small choroidal melanoma

1.  Cheung A, Scott I, Murray T, Shields C.  Distinguishing a Choroidal Nevus From a Coroidal Melanoma.  American Academy of Ophthalmology.  http://www.aao.org/publications/eyenet/201202/pearls.cfm.  Last accessed June 6, 2014.
2.  Zolotarev F, Turaka K, Shields C.  SMall Choroidal Melanoma With All Eight Risk Factors for Growth.  http://bmctoday.net/retinatoday/pdfs/1010RT_Oncology_Zolotarev.pdf.  Last accessed June 6, 2014.
3.  Reed K.  Is It A Nevus Or Melanoma?  Optometric Management. 2011 Sept. 1.http://www.optometricmanagement.com/articleviewer.aspx?articleID=106126.  Last accessed June 7, 2014.