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Real-world experience of implementing the MOLES score in a virtual choroidal naevi clinic at a tertiary referral centre

Eye volume 38, pages 1183–1188 (2024)Cite this article

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Abstract

Introduction

The MOLES score has been validated to clinically differentiate choroidal naevi from melanomas by ocular oncologists and community optometrists. However, its utility in a virtual choroidal naevi clinic at a tertiary eye hospital without specialist ocular oncology services has not yet been evaluated.

Methods

A retrospective case review of 385 choroidal lesions in the virtual choroidal naevus clinic at Bristol Eye Hospital during January–March 2020 and April–August 2021 was performed. Choroidal lesions were assessed using the TFSOM-UHHD risk factor index and MOLES score, respectively. For both study periods, clinical outcome and adherence data were analysed.

Results

Choroidal lesions scored higher with the TFSOM-UHHD index (median 2) compared to the MOLES score (median 0; p < 0.001). Median required follow-up duration was 2 years for lesions assessed with the TFSOM-UHHD index, and 0 years for those graded with the MOLES score. Overall, 215 patients were appropriately discharged to community optometrists based on their MOLES score. Imaging requirements for the TFSOM-UHHD index and MOLES score protocols were met in 69.1% and 94.8% of cases, respectively.

Conclusion

The MOLES score was easily implemented in a virtual choroidal naevus clinic, with good adherence. It increased clinic capacity by facilitating appropriate discharges of low-risk naevi to community monitoring, allowing finite and specialist hospital-based services to monitor higher-risk naevi more closely.

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Fig. 1: The total risk factor score for lesions was higher with TFSOM-UHHD compared to MOLES.

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Data availability

Data used for this study is available on request.

References

  1. Singh AD, Kalyani P, Topham A. Estimating the risk of malignant transformation of a choroidal nevus. Ophthalmology. 2005;112:1784–9.

    Article  PubMed  Google Scholar 

  2. Damato EM, Damato BE. Detection and time to treatment of uveal melanoma in the United Kingdom: an evaluation of 2,384 patients. Ophthalmology. 2012;119:1582–9.

    Article  PubMed  Google Scholar 

  3. Shields CL, Furuta M, Berman EL, Zahler JD, Hoberman DM, Dinh DH, et al. Choroidal nevus transformation into melanoma: analysis of 2514 consecutive cases. Arch Ophthalmol. 2009;127:981–7.

    Article  PubMed  Google Scholar 

  4. Shields CL, Dalvin LA, Ancona-Lezama D, Yu MD, Di Nicola M, Williams BK, et al. Choroidal nevus imaging features in 3,806 cases and risk factors for transformation into melanoma in 2,355 cases: the 2020 Taylor R. Smith and Victor T. Curtin Lecture. Retin. 2019;39:1840–51.

    Article  Google Scholar 

  5. Roelofs KA, O’day R, Harby LA, Arora AK, Cohen VML, Sagoo MS, et al. The MOLES system for planning management of melanocytic choroidal tumors: is it safe? Cancers. 2020;12:1311.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Al Harby L, Sagoo MS, O’Day R, Hay G, Arora AK, Keane PA, et al. Distinguishing choroidal nevi from melanomas using the MOLES algorithm: evaluation in an ocular nevus clinic. Ocul Oncol Pathol. 2021;7:294–302.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Damato BE. Can the MOLES acronym and scoring system improve the management of patients with melanocytic choroidal tumours? Eye. 2022;1–7. Available from: https://www.nature.com/articles/s41433-022-02143-x.

  8. Roelofs KA, O’day R, Al Harby L, Hay G, Arora AK, Cohen VML, et al. Detecting progression of melanocytic choroidal tumors by sequential imaging: is ultrasonography necessary? Cancers. 2020;12:1–14.

    Article  Google Scholar 

  9. Flanagan JPM, O’Day RF, Roelofs KA, McGuinness MB, van Wijngaarden P, Damato BE. The MOLES system to guide the management of melanocytic choroidal tumours: can optometrists apply it? Clin Exp Optom. 2022; Available from: https://www.tandfonline.com/doi/abs/10.1080/08164622.2022.2029685.

  10. NHS. NHS Long Term Plan. 2019. Available from: https://www.longtermplan.nhs.uk/.

  11. Gass JDM. Observation of suspected choroidal and ciliary body melanomas for evidence of growth prior to enucleation. Ophthalmology. 1980;87:523–8.

    Article  CAS  PubMed  Google Scholar 

  12. Mims JL, Shields JA. Follow-up studies of suspicious choroidal nevi. Ophthalmology. 1978;85:929–43.

    Article  PubMed  Google Scholar 

  13. NHS England. NHS England» National Cost Collection for the NHS. 2021. Available from: https://www.england.nhs.uk/costing-in-the-nhs/national-cost-collection/#ncc18192021.

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Acknowledgements

The authors would like to thank Balini Balasubramaniam for her help with the data collection and previous work in this area. The authors would also like to thank Professor Bertil Damato for his invaluable comments and advice to improve the quality of our work and this manuscript.

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Authors and Affiliations

  1. Medical Retina Service, Bristol Eye Hospital, Lower Maudlin Street, Bristol, BS1 2LX, United Kingdom

    Nicholas O. T. Rees, Sarah Schimansky, Gemma Bizley & Lina Kobayter

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  1. Nicholas O. T. Rees
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  2. Sarah Schimansky
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Contributions

NOTR analysed the data, wrote and critically revised the manuscript with input from the other authors. SS collected and analysed the data, assisted in writing and revising the manuscript. GB collected the data. LK conceived the idea for this study, created and implemented the choroidal naevi protocols, critically reviewed and revised the manuscript. All authors have read and approve of the manuscript in its current form.

Corresponding author

Correspondence to Nicholas O. T. Rees.

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Competing interests

The authors declare no competing interests.

Ethics approval

As a retrospective case review, ethics committee approval was not required. However, institutional approval for this study was obtained from the hospital’s audit and clinical governance committee.

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Rees, N.O.T., Schimansky, S., Bizley, G. et al. Real-world experience of implementing the MOLES score in a virtual choroidal naevi clinic at a tertiary referral centre. Eye 38, 1183–1188 (2024). https://doi.org/10.1038/s41433-023-02864-7

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