On behalf of the MOLES team, welcome to our Australian choroidal MOLES quiz. 

Choroidal naevi, or ‘moles’, occur in roughly 2% of non-Indigenous Australians over the age of 50. It is crucial to accurately differentiate naevi from melanomas, their malignant counterpart. The MOLES scoring system for choroidal naevi was developed by Professor Bertil Damato at Oxford University to optimise referral pathways for these lesions. The MOLES scoring system stratifies these lesions into common, low and high risk naevi, and probable melanoma on the basis of colour photography, OCT and fundus autofluorescence. We want to assess how accurately clinicians can implement the MOLES scoring system using an online teaching tool and a quiz with 25 representative cases. The answer sheet is downloadable from a dropbox link at the end of this survey. 

We hope you find this quiz interesting, user-friendly and informative. You can pause and close the page without losing your answers, as long as you save before you do so. 

You do not need to answer all questions. 

First read the MOLES information sheet (https://www.ouh.nhs.uk/eye-hospital/work/documents/melanocytic-choroidal-tumours.pdf), then tackle the questions.  You can keep the guide open and switch between it and this form as you answer the questions. 

Your survey responses will be anonymous and no identifiable data will be collected. The results from this survey will be collated, analysed, and discussed in a manuscript format and presented at clinical meetings. 

We would welcome any questions, suggestions or feedback. 

If you consent to participating in the survey, please click 'Next' to begin.

Thank you.

Dr Roderick O'Day FRANZCO email: roderickoday@protonmail.com

Honorary Researcher, Centre for Eye Research Australia
Consultant Ocular Oncologist, Royal Victorian Eye and Ear Hospital

 

Prof Bertil E. Damato, MD, PhD, FRCOphth e-mail: Bertil.Damato@nhs.net

Honorary Consultant Ophthalmologist, Oxford Eye Hospital
Locum Consultant Ocular Oncologist, Moorfields Eye Hospital
Professor Emeritus, University of California San Francisco
Honorary Consultant Ophthalmologist, Royal Liverpool University Hospital 

 

The MOLES acronym highlights the most important clinical signs of choroidal melanoma. The scoring system is shown below. 

The MOLES information sheet for professionals can be downloaded here:

https://www.ouh.nhs.uk/eye-hospital/work/documents/melanocytic-choroidal-tumours.pdf

 

MOLES Tips:

• Mushroom shape: is best seen with ophthalmoscopy or ultrasonography. It may not be obvious with the Optos camera.
• Orange pigment (lipofuscin) is brightly autofluorescent and accumulates on the retinal surface of the retinal pigment epithelium.

 

 

• It must be distinguished from drusen, which are discrete, minimally fluorescent if at all, and on OCT developing between retinal pigment epithelium and Bruch's membrane. 

• If possible, thickness should be measured with OCT, which is more accurate than ultrasonography with small tumours. If OCT and US are not available, categorise thickness as 0 if the lesion looks flat, 1 if it is slighly thickened and 2 if having a prominent dome or mushroom shape. 
• Disc diameter (DD) is measured horizontally and equates to 1.5 mm. Accurate measurement with calipers or a ruler is important. 

• Enlargement must be confirmed by sequential imaging. Score 1 for probable growth if basal tumour diameter exceeds 6 DD, because the tumour must have grown to reach that large size. 
• Subretinal fluid (score = 1) can be assumed if there is unexplained visual blurring or metamorphopsia and if OCT is not available. 

You may wish to download the Oxford Eye Hospital guidelines for managing patients with melanocytic choroidal tumours here. 

You may also wish to consult Oculonco.com, an online ocular oncology atlas authored by Bertil Damato. The password is 'Ocular Oncology'. 

 

MOLES Answer Sheet