Assessing Choroidal Nevi, Melanomas and Indeterminate Melanocytic Lesions Using Multimodal Imaging—A Retrospective Chart Review
, Sadiq Said 1,2, Anahita Bajka 1,2, Mario Damiano Toro 3,4, Maximilian Robert Justus Wiest 1,2, Marc Stahel 1,2, Daniel Barthelmes 1,2 and Sandrine Anne Zweifel 1,2,*Round 1
Reviewer 1 Report
Geiger et al. report on their series of patients with choroidal nevi, melanomas and indeterminate melanocytic lesions on which they performed multimodal imaging.
This beautifully illustrated report emphasizes the importance of multimodal imaging, and the particular importance of OCT, which very well may supplant ultrasonography in the evaluation and followup for choroidal lesions, since - as the authors confirm - it allows for differentiation of benign and ominous lesions based on multiple characteristics.
The manuscript is well presented, and there are only a few points that may deserve clarification.
- The paper correlates lesion characteristics commonly used in ocular oncology to differentiate pigmented lesions with "expert diagnosis". The authors may want to clarify on which criteria expert diagnosis is based that differs from the characteristics reported here. Otherwise, the correlation of imaging characteristics and expert diagnosis would be a self-fulfilling prophecy.
- The paper reports on lesion progression, but a significant number of the nevi were not followed - should those be excluded? Also, the followup was limited with a median time of 25 months. Furthermore, ominous lesions were treated, and by definition would not have significant growth. In light of all these limitations, maybe the data on lesion growth could be omitted altogether.
Author Response
Please see the attachment.
Author Response File: 
Author Response.pdf
Reviewer 2 Report
- The authors in the introduction state that biopsy is not typically performed for diagnostic/treatment decision making. But in some centres, biopsy is becoming more common for the indeterminate lesion, so that statement is not complete. Please add some discussion and consider using this reference
Weis, Ezekiel, et al. "Gene expression profiling as an adjunctive measure to guide the management of indeterminate, high-risk choroidal melanocytic lesions: a pilot study." Ocular oncology and pathology 5.2 (2019): 102-109.
- The authors state they used OCT to measure thickness of tumors when no ultrasound was available:
- How many cases was OCT used?
- Do the authors have any published evidence that this is reasonable and OCT thickness measurements are actually measuring what we think they are, and how this relates to ultrasound thickness?
- It is confusing that the authors assessed growth rates. One would assume that most melanomas are treated right after presentation and thus growth rate can not be assessed? Can the authors clarify this?
- This study is very small with 51 eyes and 10 lost to follow-up, leaving only 41 eyes. Since approximately 5% of the Caucasian population has an intra-ocular nevus making this a common condition, it is hard to justify publishing this very small retrospective series. Can the authors work to increase the subject numbers?
- Similarly, the follow-up time was very short, median 25 months, making the discussion about growth with such a small series of patients very limited and subject to spurious findings.
- The logic and purpose of this study is confusing. I believe the primary analysis was to see if multi-modal risk factors that have been associated with nevus growth are also associated with the diagnosis of indeterminate and melanomas. Since these risk factors are the primary component of how the clinician diagnosed these patients, I am not sure what the purpose of this analysis is or what it is adding to the body of literature?
Author Response
Please see the attachment.
Author Response File: Author Response.pdf
Round 2
Reviewer 2 Report
The authors have addressed most of the issues mentioned by the reviewers:
1) In the revised version the authors did not cite the article that demonstrates that OCT is reasonable to use in small <1mm lesions. This reference needs to be inserted.
2) The sentence added about the increasing role of biopsy does not make sense. Are the authors missing "it is"
3) There appears to be 2 references in reference 42. These need to be divided into 2.
4) The major issue is the small size of the study which the authors feel they can not address.
Author Response
Open Review
(x) I would not like to sign my review report
( ) I would like to sign my review report
English language and style
( ) Extensive editing of English language and style required
( ) Moderate English changes required
(x) English language and style are fine/minor spell check required
( ) I don't feel qualified to judge about the English language and style
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Are the results clearly presented? |
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Response: We appreciate your ongoing thorough examination of our work. Your comments in the course of the first review round were essential to improve our manuscript. We have made every effort to integrate your suggestions and hope this has been done to your full satisfaction. Thank you for this second review of our paper.
Comments and Suggestions for Authors
The authors have addressed most of the issues mentioned by the reviewers:
1) In the revised version the authors did not cite the article that demonstrates that OCT is reasonable to use in small <1mm lesions. This reference needs to be inserted.
Response 1: Many thanks for pointing out this mistakenly not inserted but very important reference. We now have added this in the corresponding section of our discussion.
2) The sentence added about the increasing role of biopsy does not make sense. Are the authors missing "it is"
Response 2: We appreciate you noticing this sentence. We have now revised it to improve clarity.
3) There appears to be 2 references in reference 42. These need to be divided into 2.
Response 3: We highly appreciate such a thorough and helpful review, including of our references. We have now revised mentioned reference and double-checked all others.
4) The major issue is the small size of the study which the authors feel they can not address.
Response 4: This comment re-addresses the study's sample size, already discussed in response 4 of the first review round and mentioned in the limitation section of our manuscript. We accept your opinion, but we still believe that our sample size is appropriate compared to some other studies published in the literature on this topic.
Submission Date
05 December 2021
Date of this review
20 Dec 2021 18:57:31
