Combination of clinical factors predictive of growth of small choroidal melanocytic tumors

Objective: To better define the effect of individual risk factors and combi nations thereof on the growth of small choroidal melanocytic tumors. Design: Retrospective analysis. Setting: Clinical practice of ocular oncology. Patients: The study included 1287 patients with small suspicious choroidal melanocytic tumors, measuring 3 mm or less in thickness, managed with obser vation. Results: On multivariate analysis, the clinical risk factors predictive of growth of small choroidal melanocytic tumors include tumor thickness greate r than 2.0 mm, posterior tumor margin touching the disc, visual symptoms, o range pigment, and subretinal fluid. Tumor growth was detected in 4% of tho se patients with no risk factors. Growth was detected in approximately 36% of patients with 1 risk Factor, 45% of patients with 2 risk factors, 50% of patients with 3 risk factors, 51% of patients with 4 risk factors, and 56% of patients with all 5 risk factors. The combination of risk factors offer ing the greatest risk for growth was tumor thickness greater than 2.0 mm, t umor margin touching disc, and subretinal fluid that was associated with tu rner growth in 63% of the affected patients. The relative risk for growth w as 1.9 for 1 factor, 3.8 for 2 factors, 7.4 for 3 factors, 14,1 for 4 facto rs, and 27.1 for all 5 risk factors combined. Conclusions: Five risk factors for growth of small choroidal melanocytic tu mors have been identified. The combinations of various factors increase the risk for tumor growth from 4% if no factors are present to more than 50% i f 3 or more risk factors are present. These factors may be important when c ounseling patients with small suspicious choroidal melanocytic tumors.