Purpose: The purpose of this study is to delineate the natural history of indeterminate pigmented choroidal lesions and identify parameters from the initial visit that correlate with lesion enlargement. Methods: The authors retrospectively reviewed the records of all patients with indeterminate pigmented choroidal lesions seen in consultation at the Ocular Oncology Unit at the University of California, San Francisco, after 1975. Clinical examination, fundus photography, fluorescein angiography, and ultrasound data were examined. Investigators masked to outcome coded sequential parameters of each of these modalities. Data were analyzed using both univariate and multivariate censored data techniques. Results: Of 293 lesions, 98 grew. The 5-year actuarial rate of growth was 36%. Greater tumor thickness, presence of symptoms, orange pigment, internal quiet zone on B-scan, and hot spots on fluorescein angiography all were significant predictors of tumor enlargement (relative risk of detectable tumor growth, 〉1.8). Risk scores were calculated, and subsets with higher probability of future growth were identified. In five of the patients with growing lesions, metastatic disease developed after a median posttreatment follow-up period of 51 months. Conclusion: Most small indeterminate pigmented lesions can be followed safely by serial observation and ancillary testing. The authors identified models based on data from the initial visit that can be used as an adjunct to planning tumor management.
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