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CHRPE and Choroidal Nevus in Same Eye

Optos color imaging shows a small, flat choroidal nevus (image one, yellow arrow) along with a larger flat patch of congenital hypertrophy of the RPE (CHRPE, red arrow). The color image best shows the color difference between these lesions, with the CHRPE lesion having a more jet-black coloration compared to the nevus. The red channel (image 2) best highlights the typical somewhat indistinct margins of the nevus compared with the very sharp, round margins typical for the CHRPE. The patient is being followed yearly. Are CHRPEs and nevi dangerous? Here are some pearls: Clinical characteristics of choroidal nevi at risk for progressing to a uveal malignant melanoma were initially described by Shields et al (Ophthalmology 1995;102:1351-1361). The most recent version of this famous acronym (see Retina 2019;39:1840-1851) is To Find Small Ocular Melanoma Doing Imaging (TFSOM-DIM), which stands for To (Thickness >2mm) Find (subretinal Fluid) Small (Symptoms, vision <= 20/50) Ocular (Orange pigment) Melanoma (Melanoma hollow on ultrasonography) DIM (DIaMeter > 5mm). Although CHRPE lesions can enlarge with time (see Shields et al, Ophthalmology 2003;110:1968-1973), they carry virtually no malignant potential. Histologic RPE hypertrophy has several clinical presentations. The typical isolated CHPRE lesions and bear tracks are not associated with intestinal polyps or cancer, and thus require no systemic evaluation. Only the multiple, small comet-shaped lesions are part of the familial polyposis spectrum.