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It can be difficult for practitioners to determine the likelihood of malignancy in melanocytic choroidal tumours. This author has therefore devised the MOLES acronym to highlight the most informative clinical features, which comprise mushroom shape, orange pigment, large size, enlargement, and subretinal fluid. Each of these is scored 0 if absent, 1 if subtle or uncertain, and 2 if present. Tumours are categorised as 'common naevus', 'low-risk naevus', 'high-risk naevus' and 'probable melanoma' according to whether the sum of these five scores is 0, 1, 2 or 3 or more, respectively. Tentative recommendations, subject to future studies, include: review of 'common naevi' by a community optometrist whenever the patient attends for another reason, such as a two-yearly 'check-up' (i.e., 'self-care'); non-urgent referral of patients with 'low-risk naevi' or 'high-risk naevi' to an ophthalmologist to plan long-term surveillance (i.e., determining the frequency of assessments and whether these should be undertaken by an ophthalmologist or a community optometrist); and urgent referral of patients with a MOLES score2 (i.e., 'probable melanoma') to an ophthalmologist for immediate referral to an ocular oncologist if a suspicion of malignancy is confirmed. The MOLES system does not require assessment of internal acoustic reflectivity by ultrasonography. MOLES scores correlate well with diagnosis of choroidal naevi and melanomas by ocular oncologists; however, further evaluation of this aid in routine optometric practice and other situations is needed. MOLES should prevent unnecessary referral of patients with naevi for second opinion and non-essential monitoring of these patients at hospital eye services.摘要: 临床工作者很难确定脉络膜黑色素瘤的恶性程度。因此, 本文作者设计了MOLES首字母缩略词来突出最具价值的临床特征, 包括蘑菇形态, 橙色色素, 大瘤体, 血管扩张和视网膜下积液。如果不存在上述临床特征, 则评分为0, 如果有细微临床表现或不确定, 则评分为1, 如果存在上述临床特征, 则评分为2。根据这5个评分的总和是否分别为0、1、2或3或以上, 我们将肿瘤分类为“常见痣”、“低风险痣”、“高风险痣”和“可能的黑色素瘤”。针对未来的研究, 我们暂定的建议包括: 当病人其他原因就诊时, 应由社区验光师复查“普通痣”, 如病人两年一次的“检查” (即“自我保健”) ; 将患有“低风险痣”或“高风险痣”的患者非紧急转诊给眼科医生以计划长期监测 (即确定评估的频率以及决定是否应由眼科医生或社区验光师进行评估) ; 如果确认怀疑有恶性肿瘤, 则将MOLES评分2 (即“可能的黑色素瘤”) 的患者紧急转诊给眼科医生, 以便立即转诊至眼部肿瘤科医生处。MOLES 系统不需要通过超声检查评估内部声学反射率。 MOLES 评分对眼部肿瘤专家对脉络膜痣和黑色素瘤的诊断密切相关; 然而, MOLES评分对于诊断的辅助性需要在常规视光学门诊和其他情况下进行进一步调研。MOLES 旨在防止痣病人不必要的二次转诊以及眼科医疗服务机构对这些病人进行不必要的监测。. |
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