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Multimodal imaging risk factors predictive of small choroidal melanocytic lesion growth to melanoma: An educational study and pictorial guide

Eye volume 38, pages 798–805 (2024)Cite this article

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Abstract

Background

Risk factors for small choroidal melanocytic lesion growth to melanoma have been redefined using multimodal imaging. We explored provider ability to recognize risk factors for small choroidal melanocytic lesion growth to melanoma before and after image-based education and with and without multimodal imaging.

Methods

Providers were invited to participate in a survey assessing ability to identify risk factors for small choroidal melanocytic lesion growth to melanoma using either fundus imaging or multimodal imaging. Risk factors included thickness >2 mm on ultrasonography, subretinal fluid on optical coherence tomography, presence of orange pigment by autofluorescence, acoustic hollowness by ultrasonography, and diameter >5 mm by fundus imaging. Performance was assessed before and after reviewing an educational PowerPoint providing pictorial examples of risk factors. Comparison between groups was conducted using two-tailed Fisher’s exact test.

Results

Thirty and 26 providers completed the pre-education and post-education assessments, respectively. Post-education participants were more accurate within ±1 risk factor for lesions with zero risk factors (77% vs. 100%, p = 0.01) or two risk factors (79% vs. 91%, p = 0.03). Following education, participants presented with multimodal imaging more often correctly identified lesions with four (12% vs. 42%, p = 0.03) or five (4% vs. 39%, p = 0.004) risk factors, demonstrated lower mean level of concern for lesions with zero risk factors (2.0 vs. 1.4, p < 0.001), and expressed higher level of concern for lesions with 5 risk factors (2.4 vs. 3.6, p < 0.001).

Conclusion

Use of multimodal imaging may be more beneficial than education itself to improve accuracy of risk factor identification for small choroidal melanocytic lesions.

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Fig. 1: Methodology in survey content and distribution of ophthalmology provider cohort.
Fig. 2: Representative images of risk factors for small choroidal melanocytic lesion growth to melanoma.

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Data availability

More detailed data are not publicly available due to ethical reasons. Additional data requests can be submitted to the corresponding author. Lauren A. Dalvin, M.D. has had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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Funding

This publication was made possible through the support of the Leonard and Mary Lou Hoeft Career Development Award Fund in Ophthalmology Research, Grant Number P30 CA015083 from the National Cancer Institute, and CTSA Grant Number KL2 TR002379 from the National Center for Advancing Translational Science (NCATS). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

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Authors and Affiliations

  1. Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, MN, USA

    Robert A. Churchill & Trisha Y. C. Pecoraro

  2. Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA

    Andrea A. Tooley & Lauren A. Dalvin

  3. Mayo Clinic, Scottsdale, AZ, USA

    Odette M. Houghton

  4. Mayo Clinic, Jacksonville, FL, USA

    Arman Mashayekhi

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  1. Robert A. Churchill
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  5. Arman Mashayekhi
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  6. Lauren A. Dalvin
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Contributions

LAD and AAT were responsible for identifying the knowledge gap investigated in this manuscript, designing the survey questions, choosing representative images for both survey and review materials, determining an appropriate population to recruit from, and providing input for both data analysis and writing of this manuscript. RAC was responsible for design of pre- and post-education surveys, recruitment of participants, data analysis, drawing conclusions from the analysis, and writing of the manuscript. TYC was responsible for drawing conclusions from data analysis and contributed meaningfully to manuscript writing. OMH and AM provided feedback and impactful edits during the revision process.

Corresponding author

Correspondence to Lauren A. Dalvin.

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Competing interests

This manuscript was submitted as a poster presentation for The Association of Research in Vision and Ophthalmology 2023 Annual Meeting. This manuscript has not been published elsewhere. The authors declare that they have no conflict of interest.

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Churchill, R.A., Pecoraro, T.Y.C., Tooley, A.A. et al. Multimodal imaging risk factors predictive of small choroidal melanocytic lesion growth to melanoma: An educational study and pictorial guide. Eye 38, 798–805 (2024). https://doi.org/10.1038/s41433-023-02782-8

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