7.2 Naevus, Choroidal

Date of last review:

22/6/2026

Date of next review:

22/6/2028

Date of publication:

17/8/2026

Differential diagnosis ⁽¹⁾

Peripheral exudative haemorrhagic chorioretinopathy (eccentric disciform lesion) 
Circumscribed choroidal haemangioma 
Haemorrhagic detachment of the RPE or retina 
Age-related macular degeneration 
Choroidal metastasis (most commonly from lung or breast carcinoma)

Possible management by Optometrist

Advice ⁽¹⁾ 

Examination and Documentation 

Perform dilated fundus examination using slit‑lamp indirect biomicroscopy 
Baseline colour fundus photography is essential  
- Sequential photography is recommended to assess for change or growth 
Where imaging is unavailable:  
- Produce a detailed drawing with measurements 
- Use stable anatomical landmarks (e.g. optic disc, retinal vessels) 
If the patient is not being referred:  
- Provide a copy of the image, or access to a digital image, for future comparison should care be transferred

Ancillary Imaging 

Optical coherence tomography (OCT)
- to detect if subretinal fluid present
Fundus autofluorescence
- to identify lipofuscin (orange pigment)
These findings assist in distinguishing choroidal melanoma from large choroidal naevi

Treatment ⁽¹⁾ 

No treatment is required for this condition.

Typical dosage/duration 

(Blue text = IP, black text = non-IP)

Not applicable for this condition ⁽⁷⁾

Further management options 

Confirmed Choroidal Naevus ^(1,7) 
- Normally no referral
High-risk / Atypical Naevus ⁽¹⁾ 
- Routine referral to ophthalmology for assessment and surveillance
Follow-up may be shared between community and secondary care in line with local pathways
Suspected Choroidal Melanoma  ⁽¹⁾ 
- Refer to Eyecare Guideline 7.3 Melanoma, Choroidal

Risk Assessment and Referral ⁽¹⁾

Suspected melanocytic lesions should be assessed using the MOLES scoring system, which categorises lesions according to the likelihood of malignancy:

Mushroom shape 
Orange pigment 
Large size 
Enlargement 
Subretinal fluid

Each feature is scored 0–2; the total score determines management.

MOLES scoring system

Indicator	Finding	Score
Mushroom shape	0 = Absent   1 = Unsure/Early growth through RPE   2 = Present, with overhang
Orange pigment	0 = Absent   1 = Unsure/Trace (i.e., dusting)   2 = Confluent clumps
Large size*	0 = Thickness < 1.0 mm (‘flat/minimal thickening’) and diameter < 3 DD   1 = Thickness = 1.0 – 2.0 mm (‘subtle dome’) and/or diameter = 3-4 DD   2 = Thickness >2.0 mm (‘significant thickening’) and/or diameter >4 DD
Enlargement***	0 = None (or no previous ophthalmoscopy)   1 = Unsure (poor image quality or ‘new lesion’ but no previous photo)   2 = Definite** or assumed, if thickness > 3.0 mm or diameter >5DD
Subretinal fluid	0 = Absent   1 = Trace (if minimal and detected only with OCT)   2 = Definite (if seen without OCT or extending beyond tumour margins)
	Moles total score =

DD = disc diameter (approx. 1.5 mm)   
* Ignore thickness if this cannot be measured   
**Confirmed with sequential photography  
***Assume growth has occurred if tumour diameter >5DD and/or thickness >3.0 mm and score enlargement = 1 

Risk stratification ⁽⁷⁾

Probable Choroidal Melanoma: 

MOLES score ≥ 3 
Urgent referral to ophthalmology
- In accordance with NHS urgent suspected cancer referral pathways

Low‑ or High‑Risk Naevus / Atypical Naevus: 

MOLES score 1–2 
Features may include:  
- Dome-shaped lesion >6 mm in largest basal diameter 
- Absence of orange pigment 
- With or without drusen or trace subretinal fluid 
Routine referral to ophthalmology for assessment and surveillance  
- Follow-up may be shared between community and secondary care in line with local pathways

Typical (Common) Naevus: 

MOLES score 0 
No high-risk features 
Applies even if the lesion has not been previously documented 
No specific surveillance required beyond routine eye examinations

Related Lesions: 

Congenital hypertrophy of the retinal pigment epithelium (CHRPE):  
- Malignant transformation is exceedingly rare 
- There is a rare but important association with Familial Adenomatous Polyposis (FAP), particularly where lesions are bilateral or involve multiple quadrants 
 Management
- Inform the patient
- No routine ocular surveillance required in isolated, typical cases
- Consider advising GP referral if features raise concern for FAP, in line with local guidance

Possible management in secondary care or local/community pathways where available 

See Further management options ⁽⁷⁾

 College of Optometrists Clinical Management Guideline⁽¹⁾  

Pigmented fundus lesions - College of Optometrists *

*With special thanks to The College of Optometrists for providing the evidence framework for diagnosis and management from the Clinical Management Guidelines (CMGs) for this condition. All references to the College/CMGs are included where appropriate and form the basis of the Community Eyecare Guidelines. 

Guidance is informed by the following sources  

College of Optometrists Clinical Management Guidelines Clinical Management Guidelines - College of Optometrists  
Advisory alignment with the College of Optometrists Formulary Optometrists' Formulary - College of Optometrists  
Advisory alignment with the BNF BNF (British National Formulary) | NICE 
Advisory alignment with the Summary Product Characteristics taken from the EMC Home - electronic medicines compendium (emc) 
Advisory alignment with Scottish Health Board formularies (where a clear majority is present) * 
Advisory alignment with expert consensus (CEGG), informed by sources 2-5 above 
Advisory alignment with expert consensus (CEGG)  
“Annex C of the Statement” https://www.eyes.nhs.scot/for-professionals/legislation/

* Scottish formularies should be available within the Prescribing section of your Health Board pages on the eyes.nhs.scot website. If unavailable, contact your local Health Board for further information; Health Boards landing page  

If you have a query relating to this page, please email NSS.ComEyecareGuidelineGroup@nhs.scot

Disclaimers

CEG disclaimer for guidelines awaiting update:

The Eyecare Guidelines area of the eyes.nhs.scot website (“Website”) is intended as a reference source for education and clinical decision support and is intended for use by ophthalmic healthcare professionals working in Scotland.

As such, the Eyecare Guidelines are not intended for use by the general public and do not replace the advice of a healthcare professional. Members of the public should seek advice directly from their optometrist.

Before reading the Eyecare Guidelines or making any management decisions based upon them, all users should read the ‘supporting information’ page which gives more detail around the content of the Guidelines and useful website links [link to Supporting Information page].

Users should note that that the Eyecare Guidelines guidance is not mandatory. The guidelines will not be suitable for every situation, and they are not intended to be a substitute for specialist expertise and clinical judgement. Users assume all responsibility for using/interpreting the information within the Eyecare Guidelines section of the website. Users should also note that the Eyecare Guidelines should not be adhered to in isolation and should be considered in conjunction with other national and locally available guidance/pathways.

Users should note that Guidelines which have not yet been updated should be considered with caution. Where the Eyecare Guidelines contain links to other sites and/or resources provided by third parties, these links are provided for information only.

Accordingly, to the maximum extent permitted by law, the Eyecare Guidelines are made available on the basis of excluding all representations, warranties, conditions and other terms (including, without limitation, the conditions implied by law of satisfactory quality, fitness for purpose and the use of reasonable care and skill) which, but for this disclaimer, might have effect in relation to the Eyecare Guidelines.

CEG disclaimer for updated guidelines:

Users should note that that the Eyecare Guidelines guidance is not mandatory. The guidelines will not be suitable for every situation and they are not intended to be a substitute for specialist expertise and clinical judgement. Users assume all responsibility for using/interpreting the information within the Eyecare Guidelines section of the website. Users should also note that the Eyecare Guidelines should not be adhered to in isolation and should be considered in conjunction with other national and locally available guidance/pathways. 

Updating the Eyecare Guidelines requires a continuous process; the date of the last review for each guideline will be clearly noted on each guideline. Users must consider these dates before using the guidance.

While the Common Services Agency (“PSD Scotland”) makes reasonable efforts to ensure that the information on the Eyecare Guidelines area of the Website is correct, the Website is provided ‘as is’ and PSD Scotland does not warrant the accuracy and completeness of the material on the Website. PSD Scotland may make changes to the Website at any time without notice. Some of the material on the Website may be out of date, and PSD Scotland makes no commitment to update such material. Users should note that some Eyecare Guidelines on the Website have not been updated for several years and should be considered with caution.

Where the Eyecare Guidelines section of the Website contains links to other sites and or resources provided by third parties, these links are provided for information only. PSD Scotland has no control over, and no liability in respect of, the content of these sites and resources.

Accordingly, to the maximum extent permitted by law, the Eyecare Guidelines area of the Website is made available by PSD Scotland on the basis that PSD Scotland excludes all representations, warranties, conditions and other terms (including, without limitation, the conditions implied by law of satisfactory quality, fitness for purpose and the use of reasonable care and skill) which, but for this disclaimer, might have effect in relation to the Website. 